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
OMB No. 1545-0008 may be imposed on you if this income is taxable and you fail to report it.

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

c Employer’s name, address, and ZIP code 5758.75 49.00
DK PAINTING INC. 3 Social security wages 4 Social security tax withheld
940 AINAPO STREET
HONOLULU HI 96825
US 5758.75 357.04

5 Medicare wages and tips 6 Medicare tax withheld

d Control number
5758.75 83.50
e Employee’s first name and initial Last name Suff.
EDWIN DOMINGO 7 Social security tips 8 Allocated tips
0.00 0.00
f Employee’s address and ZIP code
EDWIN DOMINGO 9 10 Dependent care benefits
94-1090 KUHAULUA ST 0.00
WAIPAHU HI 96797 11 Nonqualified plans 12a See instructions for box 12
US 0.00
c
o
d 0.00
e

13 Statutory Retirement Third-party 12b

c
employee plan sick pay o 0.00
o o o d
e

14 Other 12c
c
o
d
0.00
e

12d
c
o

a Employee’s social security number b Employer identification number (EIN)

d
e
0.00

XXX-XX-1734 27-4541587
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
HI WH144-330-1376-01 5758.75 343.10 0.00 0.00

Wage and Tax Department of the Treasury-Internal Revenue Service

Form
W-2 2019
Statement
Copy C-For EMPLOYEE’S RECORDS.
Instructions for Employee (Also see Notice to Employee, Box 12. The following list explains the codes shown in box 12. You may
on the back of Copy B.) need this information to complete your tax return. Elective deferrals (codes
Box 1. Enter this amount on the wages line of your tax return. D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE)
Box 2. Enter this amount on the federal income tax withheld line of your tax under all plans are generally limited to a total of $19,000 ($13,000 if you only
return. have SIMPLE plans; $22,000 for section 403(b) plans if you qualify for the
Box 5. This amount may be required to be entered on Form 8959. See Form 15-year rule explained in Pub. 571). Deferrals under code G are limited to
1040 instructions to determine if you are required to complete Form 8959. $19,000. Deferrals under code H are limited to $7,700.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all However, if you were at least age 50 in 2019, your employer may have
Medicare wages and tips shown in Box 5, as well as the 0.9% Additional allowed an additional deferral of up to $6,000 ($3,000 for section 401(k)(11)
Medicare Tax on any of those Medicare wages and tips above $200,000. and 408(p) SIMPLE plans). This additional deferral amount is not subject to
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on the overall limit on elective deferrals. For code G, the limit on elective
how to report tips on your tax return, see your Form 1040 instructions. deferrals may be higher for the last 3 years before you reach retirement age.
You must file Form 4137, Social Security and Medicare Tax on Unreported Contact your plan administrator for more information. Amounts in excess of
Tip Income, with your income tax return to report at least the allocated tip the overall elective deferral limit must be included in income. See the
amount unless you can prove a smaller amount with adequate records. If o line instructions for Form 1040.
you have records that show the actual amount of tips you received, report Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a
that amount even if it is more or less than the allocated tips. On Form 4137 make-up pension contribution for a prior year(s) when you were in military
you will figure the social security and Medicare tax owed on the allocated service. To figure whether you made excess deferrals, consider these
tips shown on your Form(s) W-2 that you must report as income and on other amounts for the year shown, not the current year. If no year is shown, the
tips you did not report to your employer. By filing Form 4137, your social contributions are for the current year.
security tips will be credited to your social security record (used to figure A- Uncollected social security or RRTA tax on tips. Include this tax on Form
your benefits). 1040. See o the Form 1040 instructions.
Box 9. If you are e-filing and if there is a code in this box, enter it when prompted by B- Uncollected Medicare tax on tips. Include this tax on Form 1040. See
your software.o This code assists the IRS in validating the W-2 data submitted with your o the Form 1040 instructions.
return. The code is not entered on paper-filed returns. C- Taxable cost of group-term life insurance over $50,000(included in boxes
Box 10. This amount is the total dependent care benefits that your employer paid to you 1, 3 (up to social security wage base), and 5)
or incurred on your behalf (including amounts from a section 125 D- Elective deferrals to a section 401(k) cash or deferred arrangement. Also
(cafeteria) plan). Any amount over $5,000 is also included in box 1. Complete includes deferrals under a SIMPLE retirement account that is part of a
Form 2441, Child and Dependent Care Expenses, to compute any taxable section 401(k) arrangement.
and nontaxable amounts. E- Elective deferrals under a section 403(b) salary reduction agreement
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you
from a nonqualified deferred compensation or nongovernmental section
457(b) plan or (b) included in box 3 and/or 5 if it is a prior year deferral under a
nonqualified or section 457(b) plan that became taxable for social security
 OMB No. 1545-0008
c Employer’s name, address, and ZIP code 1 Wages, tips, other compensation 2 Federal income tax withheld
DK PAINTING INC. 5758.75 49.00
940 AINAPO STREET
HONOLULU HI 96825 3 Social security wages 4 Social security tax withheld
US 5758.75 357.04

5 Medicare wages and tips 6 Medicare tax withheld

5758.75 83.50

d Control number 7 Social security tips 8 Allocated tips

0.00 0.00

9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 0.00
EDWIN DOMINGO
11 Nonqualified plans 12a See instructions for box 12
c

f Employee’s address and ZIP code

0.00 o
d 0.00
e
EDWIN DOMINGO
13 Statutory Retirement Third-party 12b
94-1090 KUHAULUA ST plan
c
o 0.00
employee sick pay
WAIPAHU HI 96797 d

US
o o o e

14 Other 12c
c
o
d 0.00
e

12d
c
a Employee’s social security number b Employer identification number (EIN) o
d 0.00
e
XXX-XX-1734 27-4541587

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
HI WH144-330-1376-01 5758.75 343.10 0.00 0.00

Form
W-2 Wage and Tax
2019 Department of the Treasury-Internal Revenue Service
Statement
Copy 2-To Be Filed With Employee’s State, City, or Local
Income Tax Return
 V- Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up
Instructions for Employee (continued from back of Copy C)
to social security wage base),and 5). See Pub. 525 and instructions for Schedule D
F- Elective deferrals under a section 408(k)(6) salary reduction SEP
(Form 1040) for reporting requirements.
G- Elective deferrals and employer contributions (including nonelective deferrals) to a
W- Employer contributions (including amounts the employee elected to contribute
section 457(b) deferred compensation plan
using a section 125 (cafeteria) plan) to your health savings account. Report on
H- Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See
Form 8889, Health Savings Accounts (HSAs).
“Adjusted Gross Income” in the Form 1040 instructions for how to deduct.
Y- Deferrals under a section 409A nonqualified deferred compensation plan
J- Nontaxable sick pay (information only , not included in boxes 1, 3, or 5)
Z- Income under section 409A on a nonqualified deferred compensation plan. This
K- 20% excise tax on excess golden parachute payments.See “Other Taxes” in the Form
amount is also included in box 1. It is subject to an additional 20% tax plus interest.
1040 instructions.
See “Other T axes” in the Form 1040 instructions.
L- Substantiated employee business expense reimbursements (nontaxable)
AA- Designated Roth contributions under a section 401(k) plan
M- Uncollected social security or RRTA tax on taxable cost of group-term life insurance
BB- Designated Roth contributions under a section 403(b) plan
over $50,000 (former employees only). See “Other Taxes” in the Form 1040 instructions.
DD- Cost of employer-sponsored health coverage. The amount reported with
N- Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000
Code DD is not taxable.
(former employees only). See "Other Taxes" in the Form 1040 instructions.
EE- Designated Roth contributions under a governmental section 457(b) plan. This
P- Excludable moving expense reimbursements paid directly to employee (not included in
amount does not apply to contributions under a tax-exempt or ganization section
boxes 1, 3, or 5)
457(b) plan.
Q- Nontaxable combat pay . See the instructions for Form 1040 or Form 1040A for
FF-Permitted benefits under a qualified small employer health reimbursement
details on reporting this amount.
arrangement
R- Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and
o
Long-Term Care Insurance Contracts.
o
S- Employee salary reduction contributions under a section 408(p) SIMPLE plan (not
Box 13. If the “Retirement plan” box is checked, special limits may apply to the
included in box 1)
amount of traditional IRA contributions you may deduct.
T- Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption
Box 14. Employers may use this box to report information such as state disability
Expenses, to compute any taxable and nontaxable amounts.
insurance taxes withheld, union dues, uniform payments, health insurance
premiums deducted, nontaxable income, educational assistance payments, or a
member of the clergy's parsonage allowance and utilities. Railroad employers use
this box to report RRTA compensation, Tier I tax, Tier II tax, Medicare tax and
Additional Medicare Tax.
Note. Keep Copy C of Form W-2 for at least 3 years after the due date
for filing your income tax return. However, to help protect your social
security benefits, keep Copy C until you begin receiving social security
benefits, just in case there is a question about your work record and/or
earnings in a particular year.
 OMB No. 1545-0008
c Employer’s name, address, and ZIP code
DK PAINTING INC.
940 AINAPO STREET
1 Wages, tips, other 2 Federal income tax withheld
HONOLULU HI 96825 compensation
49.00
US
5758.75

d Control number 3 Social security wages 4 Social security tax withheld

e Employee’s first name and initial Last name Suff. 5758.75 357.04
EDWIN DOMINGO
f Employee’s address and ZIP code 5 Medicare wages and tips 6 Medicare tax withheld
EDWIN DOMINGO 5758.75 83.50
94-1090 KUHAULUA ST
WAIPAHU HI 96797 7 Social security tips 8 Allocated tips
US 0.00 0.00
9 10 Dependent care benefits
0.00

11 Nonqualified plans 12a See instructions for box 12

c
0.00 o
d 0.00
e

13 Statutory Retire Third-party 12b

c
employee ment sick o
d 0.00
plan pay e

o o o 12c
c
14 Other o 0.00
d
e

12d
c
o 0.00
a Employee’s social security number b Employer identification number (EIN) d
e

XXX-XX-1734 27-4541587

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc 19 Local income tax 20 Locality name
HI WH144-330-1376-01 5758.75 343.10 0.00 0.00

Form W-2
Wage and Tax
Statement
2019 Department of the Treasury-Internal Revenue Service

Copy B-To Be Filed With Employee’s FEDERAL Tax Return.

This information is being furnished to the Internal Revenue Service.
to correct any name, SSN, or money amount error reported to the SSA on Form
Notice to Employee W-2. Be sure to get your copies of Form W-2c from your employer for all
Do you have to file?Refer to the Form 1040 Instructions to determine if you are corrections made so you may file them with your tax return. If your name and
required to file a tax return. Even if you do not have to file a tax return, you may be SSN are correct but are not the same as shown on your social security card, you
eligible for should
a refund if box 2 shows an amount or if you are eligible for any credit. ask for a new card that displays your correct name at any SSA office or by
Earned income credit (EIC).You may be able to take the EIC for 2019 if your adjusted calling 1-800-772-1213. You also may visit the SSA at o www.socialsecurity.gov.
gross income (AGI) is less than a certain amount. The amount of the credit is based on Cost of employer-sponsored health coverage (if such cost is provided by
income and family size. Workers without children could qualify for a smaller credit. You the employer).The reporting in box 12, using code DD, of the cost of
and any qualifying children must have valid social security numbers (SSNs). You employer-sponsored health coverage is for your information only. The amount
cannot take the EIC if your investment income is more than the specified amount for reported with code DD is not taxable. Credit for excess taxes.If you had
2019 or if income is earned for services provided while you were an inmate at a penal more than one employer in 2019 and more than $8,239.80 in social security
institution. For 2019 income limits and more information, visit www.irs.gov/eitc.Also see and/or Tier I railroad retirement (RRTA) taxes were withheld, you may be able to
Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is claim a credit for the excess against your federal income tax. If you had more
refunded to you, but only if you file a tax return. Clergy and religious workers.If than one railroad employer and more than$4,836.30 in Tier II RRTA tax was
you are not subject to social security and Medicare taxes, see Pub. 517,Social Security withheld, you also may be able to claim a credit. See your Form 1040 or Form
and Other Information for Members of the Clergy and Religious Workers. 1040A instructions and Pub. 505,Tax Withholding and Estimated Tax. (Also see
Corrections.If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and Instructions for Employee on the back of Copy C.)
ask your employer to correct your employment record. Be sure to ask the employer to
file Form W-2c, Corrected Wage and Tax Statement, with the Social Security
Administration (SSA)