Tax Year 2016
W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
b Employer identification number (EIN) d Control number Void
Copy B — To Be Filed With Employee's FEDERAL Tax Return This information is being f2urni0she1d to6 the Internal Revenue Service.
c4 E1m-p3lo9ye2r'1s n8a4me7, address, and ZIP code APX-W2-AUTO a Employee's social securityT nAuXm bYeErAR
Apex Marketing Solutions LLC
3500 West 76th Street, Suite 200, Edina, MN 55435
XXX-XX-8888
e Employee's first name and initial Last name Suf. f Employee's address and ZIP code
Sam Chen 3215 Lakeview Circle, Wayzata, MN 55391
1 Wages, tips, other compensation 2 Federal income tax withheld
$78,000.00 $13,600.00
3 Social security wages 4 Social security tax withheld
$86,000.00 $5,332.00
5 Medicare wages and tips 6 Medicare tax withheld
$86,000.00 $1,247.00
7 Social security tips 8 Allocated tips
10 Dependent care benefits 11 Nonqualified plans
12 See instructions for box 12 13 / 14 Checkboxes and Other
12a 13 Retirement plan
3
D $8,000.00
1125b State Employer's state ID number 16 State wages, tip1s,4 e tOc.ther 17 State income tax
MN MN-413921847 $78,000.00 $4,800.00
18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement 2016 | Employer: Apex Marketing Solutions LLC (EIN 41-3921847) | Employee SSN: XXX-XX-8888 | Synthetic demo data only — not for tax filing purposes
