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[Pages:1]b Employers identification number c Employers name, address, and ZIP code

e Employees name, address, and ZIP code

12a See instructions for Box 12

Code

$

12b

Code

$

12c

C

o d e

$

12d

C

o d e

$

12e

Code

$

This information is being furnished to the Internal Revenue Service.

1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 7 Social security tips 9 Advance EIC payment 11 Nonqualified plans

2 Federal income tax withheld

4 Social security tax withheld

6 Medicare tax withheld

8 Allocated tips

10 Dependent care benefits

13 Statutory employee

Retirement plan

Third-party sick pay

CONGRATULATIONS Copy B for Employees 14 Other Federal Tax Return d Employees soc. sec. no

TEST COMPLETE 15State EmployersstateI.D.No.

16 State wages, tips, etc. 17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name

Form W-2 Wage and Tax Statement 2003-Reissued

Department of the Treasury-Internal Revenue Service

OMB # 1545-0008

Copy B To Be Filed With Employee's FEDERAL Tax Return

b Employers identification number c Employers name, address, and ZIP code

CLOSE

e Employees name, address, and ZIP code

THIS

12a See instructions for Box 12

Code

$

WINDOW TO 12b

Code

$

12c

C

o d e

$

12d

Code

$

12e

Code

$

1 Wages, tips, other compensation 2 Federal income tax withheld

CONTINUE 3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

7 Social security tips

8 Allocated tips

9 Advance EIC payment

10 Dependent care benefits

11 Nonqualified plans

13 Statutory employee

Retirement plan

Third-party sick pay

Copy 2 for State, City or 14 Other Local Tax Departments

d Employees soc. sec. no

15 State Employers state I.D. No.

16 State wages, tips, etc. 17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name

Form W-2 Wage and Tax Statement 2003-Reissued Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy 2 To Be Filed With Employee's State, CITY or Local Tax Departments

b Employers identification number c Employers name, address, and ZIP code

e Employees name, address, and ZIP code

12a See instructions for Box 12

Code

$

12b

Code

$

12c

Code

$

12d

Code

$

12e

Code

$

1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 7 Social security tips 9 Advance EIC payment

2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits

11 Nonqualified plans

13 Statutory employee

Retirement plan

Third-party sick pay

Copy 2 for State, City or 14 Other Local Tax Departments

d Employees soc. sec. no

15 State Employers state I.D. No.

16 State wages, tips, etc. 17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name

Form W-2 Wage and Tax Statement 2003-Reissued Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy 2 To Be Filed With Employee's State, CITY or Local Tax Departments

b Employers identification number c Employers name, address, and ZIP code

e Employees name, address, and ZIP code

12a See instructions for Box 12

Code

$

12b

Code

$

12c

C

o d e

$

1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips

12d

Code

$

7 Social security tips

12e

Code

$

9 Advance EIC payment

This information is being furnished to the Internal

Revenue Service. If you are required to file a tax

return, a negligence penalty or other sanction may 11 Nonqualified plans be imposed on you if this income is taxable and you

fail to report it.

Copy C for Employees 14 Other Records

(See notice on back.) d Employees soc. sec. no

2 Federal income tax withheld

4 Social security tax withheld

6 Medicare tax withheld

8 Allocated tips

10 Dependent care benefits

13 Statutory employee

Retirement plan

Third-party sick pay

15 State Employers state I.D. No.

16 State wages, tips, etc. 17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name

Form W-2 Wage and Tax Statement 2003-Reissued

Department of the Treasury-Internal Revenue Service

OMB # 1545-0008

Copy C for Employee's Records

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