9-AdY3DCe

Be pnynumt

Soei21 securitytips

e Allccamd

tips

~ Advance

EIC payment

100ep200e.,tC3fe1Jenl2fllS

11 NonQualir&ed plans

? See msrrucnons
~

fer box '2

b :mpl~r

idcntifieation_nwnber"

{eN)

-.
emp.'cyeC plan

13S<a!uIc'Y R..""".",

"'Ird-pany
side. pay

r
I

a EmplO"Jee'S social

c-rfl"tv

umber

b Employer

11~

_number (EN)

a Elnp-toyee's social securttvnumber

CHARITY

120.00

0: Empfoyee"s name, address and ZIP code

MARY P. MARSHALL

201 OI ... I r RECORDS

d'G5AstateEmp1O)'Cr'SS!dttlfOND...

"l6State:w~.tiFS.e1C. _~?T24.0:4

201 QI.1~
~ W-2
Copy B To With Emplo, e Filed ee's

Employer's ~

10 No

16 St2ro . ~~cs~ ~~.s. (!tt:427?~:..~

~ W-2
CopyC -For EMPL.OYEE'S

::;~~:Ti!X

.~.~_~.~~~_~~_~118Loca'Wagcs.tipS,dl:.

t~:~:~;~T41.'l;

f7Staleim::ometax

2208.55

18~OC~I"'J3g~,tiPs,.etc

..

-tj
tmc: !!20 Locality

+at.eectreeemc

(Sec Notiretc Emplayccon back of Copy B.)

...

name . ,_~.

..

FEDERAL. Tax Return

19loeal tnccme tax ---- ..--.---.----.--

20 Lccauty

name ----

~-------

OMBNO.1~

"lSoci<!Jsccunty\.-'3gClS

4 Social security tax \'lHhhek:l

OMBNO.154$.000B

3SOc:ial~I"Titywages tips.

4 Soci,alsecurity1aXwithhekl

5Medk:muw.:g-~andtips

6r(~tu.~ 42724J14

5l,lt:!dicarewa..~"nd

r;~~1aXvri".Jlhejd

619.47
C EmpIoyats name, aecress, anti ZIP Code

42724.04 DEKALB COUNTY BOARD OF EDUCATION 1701MTN IND BLVD STorIE MOUNTAIN, GA 30083-1027

619.4

c Emp}oyer"'s name, address,

300 Z!P code

DEKALB COUNTY BOARD OF EDUCATION '701 MTN INO BLVD STONE MOUNTAIN, GA 3OOll3-1027

7 seear

security-tips

8 Allocated tr))S

9 Adl.'anee

EIC payment

7 Sada! security lips

8Allpeate<J tips

~ Advance EIC payment

10 eepeneenrcare

bOl'neftts

1"f Nonqualiffed

plans

120

11 rlonqu3lifrro plans

'23

~
12b 12e

12<

~
b Employer identificati:m

~
num!wr (ElN) tr E:mployer identifIcation

~
number
{eN}

a Emp.~,.ees social s:ecurtty number

13StaMory

c.rnpDjt!C!

Re1Kement
plan

Third-party
sickpay

1'14 Other

CHARiTY

120.00

13Sla1!m>y . RC!ircment 11>"'_"4""'''cmp!oyeC

plan.

sick pay

rr -f2IT.llU

201 0 I
~ W-2
~

f&~tJW

~mp!oye,.s state

10 No.

116

Strtc wa9CS,

tips, C~2724.04

201 0
~ W-2

11~~ta

f'Ploye;,S

~te 1tUiQ_

1G State

wage$. tips. e~4.:?I24.04.

Wog e a nd Tcx Statement

17S!2!einccmeta:x 19 L0C21 income t2.x

2208.551

.!'8l.O<alV.-'-~""'r2tll..oc?Iity name
_tntll:rn31Revefl'J:o seviee

~:,:~

Tax

l1Statt!~tlX

2208.55

1~~~a~~~~.

Copy 2-To Be Filed With Employee's State, City, or Local lncome Tax Return.

Copy2~T() ee FiletfWith Empioyee's State, City, or

Local Income Tax Return.

19Lc-eal mccme tax

20 Loeality name

~e1\;ut~l)rd of tho ;r~..uy

DEKALB COUNTY BOARD OF EDUCATION 1701 MTN IND BLVD STONE MOUNTAIN, GA 30083-1027

Social

se:urftVtips

aAI~ato!d6ps

8 Allocated

tips

100epenlent~benefJts

11 Ncnquanrredplans

'c2a See instructions for box 12

11 pronqualifiCKI

plans

\l

Employer

identirecaUon

number {EJNI

a EmplOyCe's

social seeu

numbc1"

CHARITY

120.00

n*~i<:tMlg:l~ !Odnt:tc:md~$efv::a.tf
)'OU_~UI.1I1ID:~ 4l~~Uf~hot" ~fTlfYw"'~otIVOO

~re~i:i~~yw
!:dlOr1OJlCft.t.

15 St<nD wagcs.

tips.,

etc. 35!i~1,94 ups, etc. 17 state

19lo~1 income

16 SI2tewages,

tips.

........_ tax'804.07 .'.~ ~1

ere, ..' _35527,34

~t;.

wageandT"" Statement
on

17 State income

tax . 18!)4.07

IS

local

wages,

Wages .~~~

~opyC-Fo, EMPLOYEE'S RECORDS

{See Notice to Emp!oyee back of Copy S.)

19 Local lnccme tax

income-tax

20 Locality name

1 Wages. tips., othercompensa~n

2 ~1

in~~t3Y.wittlhe~

1W~ses,bps.atha"~

2Fc!dcr.'llin=omc!t:n:~hclcs

35521.94

2$51.55

35521.94

2651.5

5 fl.OOlGlrewaQeSam; I;. f;mpJcyer"s name. address :md ZIP code

ti9S 35527,94

5r.~taxWltflhekt 515.15 c ~ploycl"'S

l~rt1edic:are~3Odttps 35527.S4 name, address ene ZIP cede

SMeo:l~raxwtthtle!d

515.1.

DEKALB COUNTY BOARD OF EDUCATION 1701 MTN INO BLVD TONE MOUNTAlN, GA 30~1021

D KALB COUNTY BOARD OF EDUCATION 1 01 MTN iNO BLVD S ONE MOUNTAtri, GA 30083-1021 7

Social

Sf:(:urity tipS

;;ial security tips

8 Aliocate<Itips

11 Nonqualifted ptans

12d

a Emp.!oyee's
social

num!>er

nwr.ber

CHARITY .e Emp'.G.'\'E'C's name. address MARY P. MARSHALL

end ZiPCOde

120.00

CHARITY

120,00

16 State wages, 'bps. etc.

35527.94 Wage and Tax Statement

Copy 2-To Be Fil~ ~Vrth Employee's state, City, or Local Income Tax Return. 17 State income tax 18Loeal 129M:, tips,

etc.

t7

$ta:;:c

Incometax

18LocalW2g~.

1804-.07
19 Lee:allncome 1<:X 20 Loc<!lity name

1804.07
20 l.ocallty name

ttps.etc.

15lceallm:ome tax

DEKALB COUNTY BOARD OF EDUCATION 1701 MTN IND BLVD STONe MOUNTAIN. GA 300I/S-1027

FIRST-CLASS MAIL U,S, POSTAGE PAID STONE MOUNTAIN, GA PERMIT NO. 12

1 wages, tips. 0It2rccmpensa.ti.cn

2 fQ4cral

income:

tax wr.hh~d

1Wages,:ips.other~..89 CMBNO.154S-CXDB nJs~nisbEtng 3 SOCi31 security -.wg.0S

2R!odc:raJtncom~tax~~72 4 So;ial sec:urity tax wrthhGtd

32938.89
3 Soci:rl
sectlri~

2815.72
4 Sc!=ial so:curity tax v.ri1hheld

wagC!S

5 Medicarewagesand tips

6 Medicaretax withheld

:=-".:.::.,
4n.65

!-5:-:'-:-'' ' -::-'' ' -' -W-.g-''-'-' ' -:-::"-PS--+.-:C'' -' ' ' i",,-,.-'' ' -W"7 th,-,C-,.'-,.:---1
j.

32938.89
c Employer's name, eaercss and ZIP code

s.r.'re

32938.89
and ZIP code

4n.65

c Employ~(s name, address

OEKALB COUNTY BOARD OF EDUCATION 1701 MTN IND Bl.VD

STONE MOUNTAIN, GA 30083-1027

DE<AL!l COU"!TY BOARD OF EDUCATION 1701 MTN !ND BLVD STONE MOUNTAIN, GA 3O()83..1027

7 SociOlI s:urity

tips

8 Allocated

tips 1Ja See Instn:ction:s ft;r box 12 1 DO 5400.38

7 SocIal

security

tips

8 AHocated tips

~OOcpcndcntcarobenefits

11 Nonqualffied plans

100epende:ltca~ber..e:fils

11 NonqualiliccJ plans

1;Za see Iostrucncns

DO

rcr

box 12

5400.38

r
b EmplOYer kfCntiftcc1t!OD nUm:DerlElt-l)

fa Empl~~,!,n_um_""

__

-ll

c Eml>loyee's name. address

20121'~"t~'~(~stateInNO
~W-2
wage and Tax
Statement 17 S!atc mceme tax

-.
0:'1

13 SbtUtDTy em.ployee

Retirement pian

Third-pOlrty sidt pi'rf

1'4

Other

CHARlTY

120.00

znd ZlP ccce

1& Stilte wages-. bps. etc.

. 3293~.~
18 Local wages, tips, etc.

201211~r.EInpk>l'"(S--1n""
V.rnge aM Tax Statement Copy 8 -To Be Filed Wrth Employee's

16 State wages, tips, etc. 329;JS.89

",.1~~9,~~
, 9 LOC4!I income tax 20 Locality name

~WM2

CopyC-For EMPl.OYS:SRECORDS
(See Notice to Emp!'oyee back of Copy S.)

19 Local tnccmc rax

20 LocaJUy name

FEDERAL

Tax

Return

d Control

Numoor

1 Wages, tips. 02herC01npiN1sztian

2 Fedc:r.ll

incol'l'lt1

t;1Xvntht'.old

d Control NumbO'r

1 waaes, rlps. CIft1cr campens<rtJon

FcdtYaI

itJc::ln:K!taxwlthhe!d

1OMSNQ 1545-OOCB

13SocialsecurityW39($

3"2$;.;.,_38,,.8,,9+4SxialSQalritytlxYit'.tm.mi

2,,81_5-.;.1-12
OMBNO.1~008 3Soci&dsccunty'.'/;lfICS

32998.89
4SociaIseani:fytlxy.ithhe!4

2815.12

5 Medic:al1! vr.ages andbps

Gf'\.1cdicare

taxwi1hhcld

5~re~3Ildtips An.S5
c Employ.!r's 1701 MTN name, address and ZIP code

32938.89
c Employer's name. address arrd ZIP code

6,tcdiearetaxvrithhekf 32938.89

4n.85

OEKAl.B COUNT'! BOARD OF EDUCATION 1701 MTN IND Bl.VD STONE MOUNTAIN, GA 30083-1027

DEKAU! CQUNr(

BOARD OF EDUCATION

INO BLVD

STONE MOUNTAIN, GAS1lO83-1027

7 Social security tips

e Ailocated tips

7 secter security tips

8 AUoc;ared tips

WDcpcndentcaro~

11t~onqualifie.dpjans

120

10 OepeOOentcare benef!tS

1 t Nonqualified

plans

123

DO

!
b Employer kientfficatlon number (BN)

DO!

5400.38

12.

~
13 _.,.
cmp!oye>iI

Emp'oyerldentffic;ttjQ!UllImber(ElN)

ll'"-=
pbn

i
I

=r
ski<. pay

120

laEmplC)'OO'~

a EmpI~'s

scdal security number

CHARI

120.00

135t1tU!o<y R_ """""""'. plan

".~ sicIt~

1'4Ot"er

CHAffiIT

.'---1
r.!lIJ"

16 state

wages,

tips, etc.

.. . , __

.. '...

..32~3.8.!!9

11State incometax 18Localwages,tips, eee. . 1620.52 ..._ ._. __._..... _..... _ Copy 2To Be Filed With Employee's State, Crty, or Local Income Tax Return.
19 t.eear mccme tax
2G Locality name

Copy

2- To Be FH@d \Vith

20 Loca!tty

name

Employee's stare, City, or Local Income Tax Return.

DEKALB COUNTY BOARD 1701 MTN IND BLVD STONE MOUNTAIN, GA

OF EDUCATION
30083-1027

FIRST-CLASS MAIL us, POSTAGE PAID STONE MOUNTAIN, GA PERMIT NO. 12

2 Federal

irIcoIIIac tax wtthheId

1287.30

5 Medk:arewages ancI Ups

3M e ~s name, address. and ZIP ICOIk!

1:lEKAl.B COUNTY BOARD OF EDUCATION

'1701MTN!NO BlVD
STON,EMOUrITAlN, GA30083-1027

lr

see inslrvclions C

for box 97.60

12

.19 Lacallneeme tax 20 Locality name 19 Local Income lax

a.B'r' 3 _
1 Wages.Ups, . 5
c Employa"s

c:omponsdon

2 __

",,_ 1287.30

'_Ups,_~2 30103.8'

__

""_ 1287.~

30103.83 6_ 30103.83 _

436.
e 11mpI"Iior'. _. adcIn!ss. and ZIP cade tJa(AI)s COUNTY BOARD OF EDUCAnoN 1101l1jTN lNJ) BLvp STONE MOUNTAIN.GA ~1027

name, addre:ss. and %lP code

DeKALB COUNTY BOARD OF EDUCATION ~~~~~:. GA3008:>-1027

I
7 Soc:fal

rritytips

8 AUocatod

tips

9 Advance

EJC payment

7 Social FrIIY

tips

8 Allocat:rd tips

100ependent~benefits

11 Honqualified pIaRs

97.80

97.60

201 OS~_~$_~IDNo.
~w~
Copy

To~Filed WIllI E"mpJo 's state, City, or

::=Tax
Tax Return.

1-19-L-ocaI-;-nct>IIU> -.--+2Q-L-oca~i~y-'- __ -,- __

LoeaIlncome

DE 5T

17~INDBLVD

-T

J
I

_ ....

~wJI
i

wagean~IT"" StatelTlellt
~~or 19 Local income tax

----i

...,-,-::..1.._.,--.==-=-=-::'

T........,_.--

~~:-i""~~~
loeall

omeTax Return.

L---;; =~=,=.:::"';:_::-;;T_==.-::_=::;;;

=::-_;:;;;;;.-:

8 COUNTYBOARDOF EDUCAnON MOUNTAIN, GA 30083-1027

I,

000008488
OMS NO.1fl45.OOO8 3 Soclal8ecurtlywag

29817.00

1289.88
4 Soclll .eeullly tax withheld
S Medlcal1ltaxwIIhheld

000008488
OMB NO. 15460008 3 Socl.' aecl/lily wagall 5 Medicare~ge.and-t!pa

29817.00

UUUI 4 Socia' .0cul1ly tax wIItIhoW

& Medicare wages and tips

-S-MedlcATe-tax withheld

291117.00
--

432.38

29817.00
c Employer's name. addreaa and ZIP coda OEKALB COUNTY BOARD OF eOIJCA liON 1701 MTN INO BLVD nONE_MOUNTAIN. GA.301lB3.1 027

--

--

432.3

c Employer'. lIame. acidr.aa a~d ZIP code

DEKA!..B COUNTY BOARD OF EDUCATION 1701 MTN INO BLVD STONE MOUNTAIN, GA 300831027
7 Social eurlly tip.
10 Dapendant caro bentllta 8 Allocated tip. 9

7 Social 8ecurlly tlpa 10 Dependant care benefits

8 Allocatod tips 11Nunquallflod plans 12c

9 12a

11 Nonquallfled plane

12a

12b

I b Employer Identification
13Statulory employee

I 12c 12d I I \a Employee'aI I number (EIN) Iocial security number

C

& K

39.80
12b

~
12d

C \

39.Q(

I i I b -employor Idontlflcatlon number (EIN)

~
13Slalutory employoo

\11 Employee'.

I
loclalaecYrily number

ReUrament plan

Third-party 140thor lick pay

Rotiremanl plan

Thlrdparty 140thor sick pay

e Employal'a nama ddra and ZIP code

-IW-2
FHOM:

o Employaa'. name. address and ZIP code

20 11

r~~~t.~I~~~I~~~~~.~:~~~ 10 No.

II ....................... ~~.mA~Q 20
wlIgea. tlpa. etc. tax 20 Locality name

1'6 State

-- ~~a~y~~~~~~~ .. ~
11\.:
~.t~~e10 No.

116 State wagoe. tips, etc. ......... _.. _.. _._._.. _~!I.lm9(

--

118 Local wages. tips. etc. Wage and Tax I,Tlltat. Income t8X ............... 'AG9,OA .................................... Statement 19 Loc.llncolllt

IW2

Wage ami Tax Statement

-1-7 State Income tax 19 Local Income tax

........ _._ ... _.... H~~.04 .- . ....................

Depar1ment or

--

18 Local wagel, tip". etc. .-. #"

Copy 2To Be Flied With Employee'. State. City, or Local Income TalC Return.

.................... ....... - ....... - .. ........................... - .... - ...

Department of thl TrealUry Internal Rev.nul aervlce'

Copy He Be Flied With Employee's State. CIty, or Local Income Tax Return.

20 Locality name

.... '.

u,. , ury .Intlrnal

Revenue aurvici

OEKALB COUNTY BOARD OF EDUCATION 1701 MTN INO BLVD STONE MOUNTAIN. GA 300831027

FIRSTCLASS MAIL U.S. POSTAGE PAID STONE MOUNTAIN, GA PERMIT NO. 12

FIRST-CLASS MAIL
Important Tax Document Enclosed

,'-BRENDA

LANE

dc......._ .-r.u_
e ~

,__ -_ 3___ 4__ --~

........ -_2 __

taX_ 127

rtaml!. ackfRSS.and ZlPc:ode

!lK'U.B coumy BOARD OF EDUCATION 1101 MTN INO BLVD jONE MOUNTAIN, GA-"f1Z1

--

7_'_1Ip<

..".......1Ip<

7SadoI_1Ips

a_lip<

I
,:0.

.2< 5941M

""""j""'_number(ElN)

13

T ,...
_~

-pay

~012.~staIe .......
S_,D

16 __

tipo,,",,~ 20~2~~~~~tD""IWr2
==TOX ~~a.FlledWilll '5 Stafl>. CIty, Of Locaf _ Tax ReCum.

~__~_~~~-M
20.

1~-2
I.DcaIIncorne

=:Tax
Tax. Return.

~~~~t~O!D
19loeallncametax

~~~~
2OlOl2lityname

~_~~~-!I!I~''---tipS.eo:. 19Loca1Income""

~2-To BeFliedWilh Employee's Stafl>. CIty, or

KALB

COUNTY BOARD OF EDUCAnON

FIRST-CLASS

MAIL

101MTNINDBlVD

us, POSTAGE
PAID

S ONE MOUNTAIN. GA
~

30083-1027

STONE MOUNTAIN. GA
PERMrr NO, 12

7 Scei3f

sacurity

tips

18AJI0C3~tips

9 Adv3nce

S"IC payment

.9 P,dvar.ce

E!C

payomcllt
fOr

11Nonqualitied plans

12a See instructions

tor

box 12

?
~ !fb

See instrUctJOns

ccx

12

!?,."

.C

'l-d

umber

-c EmpIOy(c'S name, address

and ZIP code

TINA 1111. JACKSON

TMi1form;h::105btlingl\~ tDWtucrcJ ROVW1U~SoN!ca.I( ),UJ..-"reQl..lRdIOC/IOal;no:r::un, 1I1~~(J:"a:har

o Emptc:r~'s name, seeress

ana ZIP code

~ttl;rJbe-~c."'~
i!lfZn:ur. tl!toqp:ll'tiL t=llb:eOlfldlOJ

.~

O.N

16 State wages,

tips. cte .

...~..... __ .. ~._ ..... !l~~J)~~.

18 teeat wages. Dps. etc.

2 )1 OI'~~t.EroPloy.rssta"''''''6S_W'9'''"PSe!3278029
~ ~-2
~:,::~Tax 17S!<lteineometax1851.92 ~~.~~!~~~~~.~ 19local income ~x 20 Locality
name ..

~ \lV-2

;V~~~:t Tax

17 state income tax

._ ~_

1.l!li'.~'
20 LQcaJity carne

COpyC-For EMPLOYEE'S RECORDS

(see- Notiw to Employ(X;! on back of Copy B.)

1~ L.ocaIincome tax

C~.~IY B To Be Filed Wit! Empfoyee's Tax R~tum

Fer[eAAi.

..... '

oilooo7301

dCon!rolN~

1 'li:1gcs. tips.,GthtlrCO~bon

2Fed(!l"3finccrr~tnxWlthhC!d

d Control Number

1wagC$,nps.otherco~

2FeGefa1inec.-netaxwit.'YIekf

32780.29 3Soda! '5eCUritywages

5f1)edicare~andbps

3648.50
4 Social security tax withheld

oooopn01
OM NO.154s.oooa JSociaIwcurttyWilOl'$

32780.29

3648.50

OOmNO.1545-01XE1

1:1 Scdalsecurttytaxwithhe!d

SMM~mtaxwi1h.~

5 ~!care\'...ages

andtips.

6 Medicare '!3Xw.thheld

32780.
c employers; name. address, and ZlP COC1c

475.32 c
9 pIOV~1'"5. name. address. ane ZiP code

3218'0.29 KALB COUNTY BOARD OF EOLJCATION 17 1 MTN IND BLVD SIlaNE MOUNTAIN, GA30083-1027

475.3

OEKALB COUNTY BOARD OF EDUCATION 1701 MTIIIINO BLVD STONE MOUNTAIN, GA30083-1027

SOCIal security tips

8 Allocatedtips

9 AdvClnce

Be

payment

7 Sial

security liPS

8 Al!ocattXftips

9 Advanee

EIC payment

D E ployer Id(!o:rtJtJc;:Jtion ~~

(EINJ

a Emp!~s

socialsccuntynumber"

~~'S

name, address:l1ld

code

1~.K.SO.N""lIt

2 P1 O!
~ ~-2
Copy 2-To Be Flied Worth Employee's State, City, or Local Income Tax Return.
ts t.ecet rncemc eex 20 LOC4.!litynamc

'~~~te

rp!OVC(S

state lD NO.1:
17S!al2:ncolMtax

Sta~.~g~~.~~. ~3278.0,.~~ 1851.92 18~1~~S.ctc..

20 locallty name

:~:r::~
Tax

19 leal

income tax

DEKAlB COUII.'TY BOARD OF EDUCATION 1701 MTN IND BLVD STONE MOUNTAIN, GA 30083-1027

'-

AM.JA

KSON

II

--~--I

7 S=hJ! security

tips

e Allocated

tips

8 AJlocamd

tips

)23 See instnlctions for t-ox 12

}f<=

'ild

j
r (ElN)

b Employer

Idenf

I
1'4

a Emp!oycc's soci~1 secu~numoef

13St!tl""Y en!PIC)""

2011 rLt_~,~l=~~~ ~~~_~~~~~~h?l?~~ ~ W-2 ~~:i;::Tax :~~~~.e_~~_q1..~~_ t8loc<ll etc.

wages. tips. CopyC -Por EMPLOYEE'S RECORDS (Soo Notice to Emp!oym;o: on back of Copy S.) i9 Local Income tax 20 LOt:ality name 19 Lecar Income tax

e Emp!~e'$ 1

10_, Sidl:pay

Other

name, address. ana ZlP code

nM.~ "~~!:yG(mv::-

~:r~

to:ba~Rorw:ntIIlSuvi=o..I1 yilU'"'~tD1leO!lC\Xr-:n.r1, s:t'ICt.onrhllybc~Cf'lYOU

il'thisb:otnttst.n:tio:w'>dyou tailwn!patit.

16 state

wages, ups.

ctc~171.~:

20 Locality name

d Centrel Number

,,'/ages,

tips.. other COmpctlsation

2 Fodotal incoma!tax \v!thhGld

000007312
0;.16OO154$OOOEt 3 SOc!af securtl"j wages

31715.55

4002.55
4 Soci2J security tax W'ithhdd

d ctontrol Uumber ooo!)7312

1 Wages, tips, ather compcn$oltlon

2 Fcderalinccmetaxwithheld 4D01.S5

31715.55
3.Sccialsecurifywages

at e

NO.

f545-0or...s

5 Medicare

W3g(:S and tipl;

6r~et2X:\,;fthMfd

S Mec:&2re '..vases and tips

G Med!eare tax vrittl.!lClt!

31715.55

453.91

31715.55
c Employer'S name. address and ZIP code 'EKALB COUNTY BOARD OF EDUCATfON

459.91

c Emp!oyei'S name. aceress aec ZIP code

OEKALB COUNTY BOARO OF EDUCATION 17Dl MTN INO BLVD STONE MOUNTAIN, GA 30083-1<127

7 Sodal $e'Cunty tips

8 auecatcs

tips

1 01 MTN

mo

BLVD GA

rosa

MOUNTAIN,

30083-1027

8AIIOCCItiidtips

10Dep::!ndMtte3re~

1f Nonqu~IIRcd pbns

"'0 ~
'20

12b

12c

~
R~

I
fa Emp!oyee'S

b Employer

2011 ~'~ra"'Empl--S.",ur
~ W-2
WageandTa.
statement
17

-c Emp!cyee'S name, address

"emplcyee

identif'lCation um~r (EIN)

eer

number

plan

Th"""""""/'40 .
SlCiC.pay

and Z1? code

state income tax 1815.33

16 stat>: w-ages.

tips.

etc . S~715.~
tips. arc,

011
~ W-2

16.state

wages, tips, EtC.

..3171~~~

18

Local

Yo'2gQS.

~?:r:!~tTax
19 Local mccm e tax 20 Locality name

Copy 2-To Be- Filed With EmplOll"e's state, Crty, or LocalIncomeTaxRetum.

ts Lccaf Ieccme tax

~r.=ntortI'1(>T~.INOfn3IR

20 Locality

name.

py 2-To Be Filed W'Jth E pJoyee's state, Ctty, or L at Income Tax Return

ro""""

DEKALB COUNTY BOARD OF EDUCA nON 1701 MTN IND BLVD 'STOII!E MOUNTAIN, GA 3Oll83-1027

RRST -CLASS MAIL U.S. POSTAGE PAID STONE MOUNTAlN, GA PERMIT NO. 12

r \ :

J -::< k'q ( 10/ ",....)...:..1-.....1.

d Con;roINumber
OMBNO.151SGX8

1 Wages. 'llps.ottlefc::c::mpensati( 2 Federal 32280.95

S Sod.at ~wages

tnccme

tax withheid 4141.22

1 Yiages.. tips. CI!t1e!"COt'l1pensattcn

seeerarinccme

t1.x WI1hh~ld

32280.95
3 Sociaf security
vages

4141

5 Medicare wages anct tips

6 fftedicare

tax . thheld

5 Medicare ""r.lg(!Sand tips

G Medlc"dn:! t.no:withhnld

32280.55
c Employer's name, address and ZIP code

468,04
c mployc:t's name, address and ZIP code

32280.95 EKALB COUNTY BOARD OF EDUCATION 11701 MTN IND BLVD VONE MOUNTAlN, GA 30083-1027

468.04

DEKALB COUNTY BOARD OF EDUCATION 1701 MTN IND BLVD STONE MOUNTAIN, GA 30083-1027

7 Social

St..."'Curity tips

8 Allocated

tips

7 roelOJI security' tips ptans 123 see instructian$ for box 12

S AtlOC<!ted tips

10 Oeper;der:tcare benef:ts

11 Nonqu.attfted

11 Nonqualffi!!d

plans

1,,23 See instructions

for box 12

DO,

G024.7S

00

6024.76

(2"

1
b EmplO'fCr idcntificatioD1'l!J.mber (ElN)

a Employee'$ social SE<'~umber

13 S2tuI:ory
emp!~

. I

R~er&: pcan

~ Sic:kpay

j'140ttJef

I
e E'mploye'2's

iiiiia
Wage and Tax Statement on

name, address

:ind ZIP cede.

nn~NbIor>gbt~ todl1)hr;m:jR~Si:IvIa!..If
YOUSllr~lCJea.a:.:RftZn

:J~pom;tyord.ho:'r

~t'WJbo~onyou
il"otW!.i'Icon'ei!:tn:ro'tieo:rd}OJ

20 121~~~~~~ers . U
~W-2
CopyC-For EMPLOYEE'S RECORDS
(S~ Notic!) to =mp'o'J~ back of Copy B.)

n
32280.35

ti:;I~~t.

16 State wages. tips, etc. 32280.95

19 local fnccme tax

20 Locality' name

dCOntroiNurrtbcr

1V~~s.~eom~"I~

2 FedcraJ

iIlCl)l'llCUIX

1!hheld

trolf~umber

4141.22
4 SOCial securttytax v\1thoo:d

'Wages.tips.~compcns;rtion 32280.95

2Fcdcr.1lineo;nc:tllt~

4141
4 Sccio _ __'_''''''_'''''Y_ _laX.,.,..'' '"' ':-:

OC\16001515<XX2

3 SooaJsec:l.!ritywagcs
5 MediC<lm w<!ge5 and tips

rm
c

NO.

1545-0009

1-,',.,S0ci3_._' __'"' '"' ._Iy_.'' ' ' ' '_..,- __

5Medfea."ewagcs~ndtips

-t

_""_d_-1
468.0

G Me<flcare tax \vithllCJd

SM..t>diCarctaY.'Irllhhc!d

32280.95
c; EmplOyers name, address and ZtP ceec

468.04

32280.95

DEKALB COUNTY BOARD OF EDUCATION 17t11MTN IND BLVD STONE MOUN"rAIN, GA 30083-1 027

~~;~~~~Ta;~~~dg;~OOUcAnON
1701 MTN IND BLVD rONE MOUNTAIN, GA
30083-1027 lal security

7 Social $~u(lty

tips

8 anccatec

ups

tips

a AU:lc;;stcd tips

10 ocpencc

n ecare tcndits

11 Nonqu31ified

pl.,ns

yb
I
b Emplo~r identification 13 St3Mll!y cmpla;o<!

yc
numbe:-{BN)

yd
J a Emp:.cye!'s

12<> 1 DO
SOCia! securnv

1 Dcperu:Ientcarebenefits

11 Nonquallfied

plans

6024.76

6024.76

number

b' mplOyCr identification 1 Stiltutoty Rcti~mcmt

nu

Relf.reme re
plan

nm"-eartY
-pay

1140"'"

e",p'o",,,

plan

IiiiiIa.
~W-2
Employee's W.aga and Tax Statement

e 8nple's

name. 3ddrt!ss" and Zli'

eeec

201211GratcEmp'OYCr'sstatc'ONO
11 ~ mccme tax

16 State

\vag.es. tips. etc.

1GState wages. tips, etc.

32280.95
18 local W<lges, Ups. etc.

3:P~Q,~5 etc.

18 local wages, tips,

1848A3
19 Local Income tax 20 Lccalrty name 19 Local income tax 20 LccaIity name

Copy 2-To Be Filed With

State. City, or

local Income Tax Return.

De;l--.rtmont of tho lfootSuty-lr.t"erml Revanua Slr-vic.

DEKAlB COUNTY BOARD OF EDUCATION 1701 MTN IND BLVD STONE MOUNTAIN, GA 30083-1027

FIRST-ClASS MAIL U.S. POSTAGE

PAID STONE MOUNTAIN, GA PERMIT NO. 12

.~.

J.

BUS

# __

PARKING __ LOCATION

DEKALB SCHOOL BUS DRIVER & AIDE TIMESHEET

THIS TIMESHEET MUST BE IN THE TRANSPORTATION OFFICE NO LATER THAN NOON MONDAY OF EACH WEEK

. "(

NAME:
PLEASE PRINT

EIN:
(MI)

OM

#
FRIDAY

DeKalb S c h
001

---

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county S Y s t e m

-----

SUNDAY

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Date: Code

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FT INS MID OTR PM REP SDV S&T

II::VI::NI ABSENT ACTIVITY MORNING ROUTE FU.ELlNG _ FIELD TRIP INSPECTION MIDDAY OTHER AFTERNOON ROUTE REPAIR STAFF DEVELOPMENT SAFE & lRAINNG

Ira

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nave

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z w SubTotal

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'U56I1, ,

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nereuy ' 1 mG.

worked all of the hours reported on,this timesheet.

'

V
'

WEEKLY TOTAL

(check)

EMPLOYEE SIGNATURE:

- - DAT~

~~

/_.....;.

........ . .. I
)

r:

f-

OM SIGNATURE:
While Payroll Yellow
0

DATE:
Supervisor Pink Employee

""

,',

.",

',-'.

;>_~1~!~
NAME:
P.LEASE PRINT

tISTI~ESHE~e~~~~~~~J~~~!~~!~~~;r~~~~~~!~F"JHW"K .--.
EIN:
(Mil

OM#--FRIDAY
Date;

D~KalbCounty
School Syst.em SATURDAY

..

'

~:.'

SUNDAY
Time

TUESDAY
Time Time Code

Date: Code Time

.
Sub Total

Cod~

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White Payroll Yellow Supervisor

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