Form W-2 Wage and Tax Statement and Form W-3 Transmittal of Wage and Tax Statements (2013)

Summary: This is an example of Schedule H (Form 1040) 2013, as pertains to the text. The line items completed are:

Form W-2 Wage and Tax Statement (2013)

b. Employer identification number field contains 00-1234567
c. Employer's name, address, and ZIP code field contains
- Susan Green
- 16 Gray Street
- Anyplace, California 92665
d. Employee's social security number field contains 000-00-4567
e. Employee's first name and initial field contains Helen R.
- Last name field contains Maple
f. Employee's address and ZIP code field contains
- 19 Pine Avenue
- Anycity, California 92666
1. Wages, tips, other compensation field contains 2429.95
3. Social security wages field contains 2300.00
4. Social security tax withheld field contains 142.60
5. Medicare wages and tips field contains 2300.00
6. Medicare tax withheld field contains 33.35

Form W-3 Transmittal of Wage and Tax Statements (2013)

b. Kind of Payer: Household employee checkbox checked
c. Total number of Forms W-2 field contains 1
e. Employer identification number field contains 00-1234567
f. Employer's name field contains Susan Green
g. Employer's address and ZIP code field contains
- 16 Gray Street
- Anyplace, California 92665
1. Wages, tips, other compensation field contains 2429.95
3. Social security wages field contains 2300.00
4. Social security tax withheld field contains 142.60
5. Medicare wages and tips field contains 2300.00
6. Medicare tax withheld field contains 33.35
Contact person field contains Susan Green
Under declaration statement:
- Signature field contains Susan Green
- Date field contains 1/30/14