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DO NOT CUT, FOLD, OR STAPLE THIS FORM For Official Use Only OMB No. 1545-0008 44444 ? D Employee s correct SSN c Tax year/Form corrected an Employer s name, address, and ZIP code /W-2 e Corrected
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SSN 12d EIC Nonqualified 12a 12b 12c W-2c W-3c LW2CA-B W-2 EIN OMB MQGE VPA AFor Suff Locality Allocated Medicare Statutory Employers withheld STAPLE corrections Reduction

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