2017 W-2 and EARNINGS SUMMARY

Employee Reference Copy This blue Earnings Summary section is included with your W-2 to help describe portions in more detail.
Wage and Tax
W-2 Statement
Copy C for employee’s records.
2017
OMB No. 1545-0008
The reverse side includes general information that you may also find helpful.
1. The following information reflects your final 2017 pay stub plus any adjustments submitted by your employer.
d Control number Dept. Corp. Employer use only Gross Pay Social Security TX. State Income Tax
26251.50 1567.40
014550 NCN3/CXA 086315 A 3048 Tax Withheld Box 17 of W-2
c Employer’s name, address, and ZIP code Box 4 of W-2 SUI/SDI
C & J SPEC-RENT SERVICES Box 14 of W-2
Fed. Income 2725.00 Medicare Tax 366.57
INC Tax Withheld Withheld
3990 ROGERDALE Box 2 of W-2 Box 6 of W-2
HOUSTON TX 77042
2. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
Batch #01755
Wages, Tips, other Social Security Medicare TX. State Wages,
e/f Employee’s name, address, and ZIP code Compensation Wages Wages Tips, Etc.
Box 1 of W-2 Box 3 of W-2 Box 5 of W-2 Box 16 of W-2
EDWIN L ROGERS
10490 EMMITT LN. Gross Pay 26,251.50 26,251.50 26,251.50
SAN ANGELO TX 76901 Plus GTL (C-Box 12) 63.72 63.72 63.72
Less Other Cafe 125 1,034.55 1,034.55 1,034.55
b Employer’s FED ID number a Employee’s SSA number
Reported W-2 Wages 25,280.67 25,280.67 25,280.67
87-0750712 490-80-1251
1 Wages, tips, other comp. 2 Federal income tax withheld
25280.67 2725.00
3 Social security wages 4 Social security tax withheld
25280.67 1567.40
5 Medicare wages and tips 6 Medicare tax withheld
25280.67 366.57
7 Social security tips 8 Allocated tips

9 Verification Code 10 Dependent care benefits 3. Employee W-4 Profile. To change your Employee W-4 Profile Information, file a new W-4 with your payroll dept.
27db-b7d3-fbf5-e832
11 Nonqualified plans 12a See instructions for box 12

12b DD
C 63.72 EDWIN L ROGERS Social Security Number:490-80-1251
14 Other 2475.85 10490 EMMITT LN. Taxable Marital Status: MARRIED
12c
12d SAN ANGELO TX 76901 Exemptions/Allowances:
____________________
13 Stat emp. Ret. plan 3rd party sick pay FEDERAL: 0
X STATE: No State Income Tax
15 State Employer’s state ID no. 16 State wages, tips, etc.
TX
17 State income tax 18 Local wages, tips, etc.

19 Local income tax 20 Locality name ¤ 2017 ADP, LLC

1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld
25280.67 2725.00 25280.67 2725.00 25280.67 2725.00
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
25280.67 1567.40 25280.67 1567.40 25280.67 1567.40
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
25280.67 366.57 25280.67 366.57 25280.67 366.57
d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only
014550 NCN3/CXA 086315 A 3048 014550 NCN3/CXA 086315 A 3048 014550 NCN3/CXA 086315 A 3048
c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code
C & J SPEC-RENT SERVICES C & J SPEC-RENT SERVICES C & J SPEC-RENT SERVICES
INC INC INC
3990 ROGERDALE 3990 ROGERDALE 3990 ROGERDALE
HOUSTON TX 77042 HOUSTON TX 77042 HOUSTON TX 77042

b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number
87-0750712 490-80-1251 87-0750712 490-80-1251 87-0750712 490-80-1251
7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips

9 Verification Code 10 Dependent care benefits 9 Verification Code 10 Dependent care benefits 9 Verification Code 10 Dependent care benefits
27db-b7d3-fbf5-e832
11 Nonqualified plans 12a See instructions for box 12 11 Nonqualified plans 12a
12 11 Nonqualified plans 12a
C 63.72 C 63.72 C 63.72
14 Other 12b 14 Other 12b 14 Other 12b
DD 2475.85 DD 2475.85 DD 2475.85
12c 12c 12c
12d 12d 12d
13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay
X X X
e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code
EDWIN L ROGERS EDWIN L ROGERS EDWIN L ROGERS
10490 EMMITT LN. 10490 EMMITT LN. 10490 EMMITT LN.
SAN ANGELO TX 76901 SAN ANGELO TX 76901 SAN ANGELO TX 76901

15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc.
TX TX TX
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.

19 Local income tax 20 Locality name 19 Local income tax 20 Locality name 19 Local income tax 20 Locality name

Federal Filing Copy TX.State Reference Copy TX.State Filing Copy

Wage and Tax Wage and Tax Wage and Tax
W-2 Statement
Copy B to be filed with employee’s
OMB
2017 No. 1545-0008
Federal Income Tax Return.
W-2 Statement 2017
OMB No. 1545-0008
Copy 2 to be filed with employee’s State Income Tax Return.
W-2 Statement OMB
2017
Copy 2 to be filed with employee’s State Income Tax Return.
No. 1545-0008
Instructions for Employee Box 12. The following list explains the codes shown in box 12. You P—Excludable moving expense reimbursements paid directly to
may need this information to complete your tax return. Elective employee (not included in boxes 1, 3, or 5)
Box 1. Enter this amount on the wages line of your tax return. deferrals (codes D, E, F, and S) and designated Roth contributions Q—Nontaxable combat pay. See the instructions for Form 1040 or
Box 2. Enter this amount on the federal income tax withheld line of (codes AA, BB, and EE) under all plans are generally limited to a total Form 1040A for details on reporting this amount.
your tax return. of $18,000 ($12,500 if you only have SIMPLE plans; $21,000 for R—Employer contributions to your Archer MSA. Report on Form 8853,
Box 5. You may be required to report this amount on Form 8959, section 403(b) plans if you qualify for the 15-year rule explained in Archer MSAs and Long-Term Care Insurance Contracts.
Additional Medicare Tax. See the Form 1040 instructions to Pub. 571). Deferrals under code G are limited to $18,000. Deferrals
under code H are limited to $7,000. S—Employee salary reduction contributions under a section 408(p)
determine if you are required to complete Form 8959. SIMPLE plan (not included in box 1)
Box 6. This amount includes the 1.45% Medicare Tax withheld on However, if you were at least age 50 in 2017, your employer may
have allowed an additional deferral of up to $6,000 ($3,000 for section T—Adoption benefits (not included in box 1). Complete Form 8839,
all Medicare wages and tips shown in box 5, as well as the 0.9% 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is Qualified Adoption Expenses, to compute any taxable and nontaxable
Additional Medicare Tax on any of those Medicare wages and tips not subject to the overall limit on elective deferrals. For code G, the amounts.
above $200,000. limit on elective deferrals may be higher for the last 3 years before you V—Income from exercise of nonstatutory stock option(s) (included in
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For reach retirement age. Contact your plan administrator for more boxes 1, 3 (up to social security wage base), and 5). See Pub. 525,
information on how to report tips on your tax return, see your Form information. Amounts in excess of the overall elective deferral limit Taxable and Nontaxable Income, for reporting requirements.
1040 instructions. must be included in income. See the “Wages, Salaries, Tips, etc.” line W—Employer contributions (including amounts the employee elected
You must file Form 4137, Social Security and Medicare Tax on instructions for Form 1040. to contribute using a section 125 (cafeteria) plan) to your health
Unreported Tip Income, with your income tax return to report at Note: If a year follows code D through H, S, Y, AA, BB, or EE, you savings account. Report on Form 8889, Health Savings Accounts
least the allocated tip amount unless you can prove that you made a make-up pension contribution for a prior year(s) when you (HSAs).
received a smaller amount. If you have records that show the actual were in military service. To figure whether you made excess deferrals, Y—Deferrals under a section 409A nonqualified deferred
amount of tips you received, report that amount even if it is more or consider these amounts for the year shown, not the current year. If no compensation plan
less than the allocated tips. On Form 4137 you will calculate the year is shown, the contributions are for the current year. Z—Income under a nonqualified deferred compensation plan that fails
social security and Medicare tax owed on the allocated tips shown A—Uncollected social security or RRTA tax on tips. Include this tax on to satisfy section 409A. This amount is also included in box 1. It is
on your Form(s) W-2 that you must report as income and on other Form 1040. See “Other Taxes” in the Form 1040 instructions. subject to an additional 20% tax plus interest. See “Other Taxes” in
tips you did not report to your employer. By filing Form 4137, your B—Uncollected Medicare tax on tips. Include this tax on Form 1040. the Form 1040 instructions.
social security tips will be credited to your social security record See “Other Taxes” in the Form 1040 instructions. AA—Designated Roth contributions under a section 401(k) plan
(used to figure your benefits). C—Taxable cost of group-term life insurance over $50,000 (included in BB—Designated Roth contributions under a section 403(b) plan
Box 9. If you are e-filing and if there is a code in this box, enter it boxes 1, 3 (up to social security wage base), and 5) DD—Cost of employer-sponsored health coverage. The amount
when prompted by your software. This code assists the IRS in D—Elective deferrals to a section 401(k) cash or deferred arrangement. reported with Code DD is not taxable.
validating the W-2 data submitted with your return. The code is not Also includes deferrals under a SIMPLE retirement account that is part EE—Designated Roth contributions under a governmental section
entered on paper-filed returns. of a section 401(k) arrangement. 457(b) plan. This amount does not apply to contributions under a tax-
Box 10. This amount includes the total dependent care benefits that E—Elective deferrals under a section 403(b) salary reduction exempt organization section 457(b) plan.
your employer paid to you or incurred on your behalf (including agreement FF—Permitted benefits under a qualified small employer health
amounts from a section 125 (cafeteria) plan). Any amount over F—Elective deferrals under a section 408(k)(6) salary reduction SEP reimbursement arrangement
$5,000 is also included in box 1. Complete Form 2441, Child and G—Elective deferrals and employer contributions (including Box 13. If the “Retirement plan” box is checked, special limits may
Dependent Care Expenses, to compute any taxable and nontaxable nonelective deferrals) to a section 457(b) deferred compensation plan apply to the amount of traditional IRA contributions you may deduct.
amounts. H—Elective deferrals to a section 501(c)(18)(D) tax-exempt See Pub. 590-A, Contributions to Individual Retirement Arrangements
Box 11. This amount is (a) reported in box 1 if it is a distribution organization plan. See “Adjusted Gross Income” in the Form 1040 (IRAs).
made to you from a nonqualified deferred compensation or instructions for how to deduct. Box 14. Employers may use this box to report information such as
nongovernmental section 457(b) plan, or (b) included in box 3 J—Nontaxable sick pay (information only, not included in boxes 1, 3, state disability insurance taxes withheld, union dues, uniform
and/or 5 if it is a prior year deferral under a nonqualified or section or 5) payments, health insurance premiums deducted, nontaxable income,
457(b) plan that became taxable for social security and Medicare K—20% excise tax on excess golden parachute payments. See “Other educational assistance payments, or a member of the clergy's
taxes this year because there is no longer a substantial risk of Taxes” in the Form 1040 instructions. parsonage allowance and utilities. Railroad employers use this box to
forfeiture of your right to the deferred amount. This box shouldn’t report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax,
L—Substantiated employee business expense reimbursements Medicare tax and Additional Medicare Tax. Include tips reported by the
be used if you had a deferral and a distribution in the same (nontaxable)
calendar year. If you made a deferral and received a distribution employee to the employer in railroad retirement (RRTA) compensation.
in the same calendar year, and you are or will be age 62 by the M—Uncollected social security or RRTA tax on taxable cost of Note: Keep Copy C of Form W-2 for at least 3 years after the due date
end of the calendar year, your employer should file Form group-term life insurance over $50,000 (former employees only). See for filing your income tax return. However, to help protect your social
SSA-131, Employer Report of Special Wage Payments, with the “Other Taxes” in the Form 1040 instructions. security benefits, keep Copy C until you begin receiving social
Social Security Administration and give you a copy. N—Uncollected Medicare tax on taxable cost of group-term life security benefits, just in case there is a question about your work
insurance over $50,000 (former employees only). See “Other Taxes” in record and/or earnings in a particular year.
the Form 1040 instructions. Department of the Treasury - Internal Revenue Service

NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS.

This information is being furnished to the Internal

Revenue Service. If you are required to file a tax Notice to Employee
return, a negligence penalty or other sanction may
be imposed on you if this income is taxable and Do you have to file? Refer to the Form 1040 instructions
you fail to report it. to correct any name, SSN, or money amount error
to determine if you are required to file a tax return. Even if reported to the SSA on Form W-2. Be sure to get your
IMPORTANT NOTE: you don’t have to file a tax return, you may be eligible for a copies of Form W-2c from your employer for all
In order to insure efficient processing,
refund if box 2 shows an amount or if you are eligible for corrections made so you may file them with your tax
attach this W-2 to your tax return like this
any credit. return. If your name and SSN are correct but aren’t the
(following agency instructions): Earned income credit (EIC). You may be able to take the same as shown on your social security card, you should
EIC for 2017 if your adjusted gross income (AGI) is less ask for a new card that displays your correct name at any
than a certain amount. The amount of the credit is based SSA office or by calling 1-800-772-1213. You also may
on income and family size. Workers without children could visit the SSA at www.SSA.gov.
qualify for a smaller credit. You and any qualifying children Cost of employer-sponsored health coverage (if such
must have valid social security numbers (SSNs). You can’t cost is provided by the employer). The reporting in box
take the EIC if your investment income is more than the 12, using code DD, of the cost of employer-sponsored
TAX RETURN specified amount for 2017 or if income is earned for health coverage is for your information only. The amount
services provided while you were an inmate at a penal reported with code DD is not taxable.
institution. For 2017 income limits and more information, Credit for excess taxes. If you had more than one
visit www.irs.gov/eitc. Also see Pub. 596, Earned Income employer in 2017 and more than $7,886.40 in social
THIS Credit. Any EIC that is more than your tax liability is security and/or Tier 1 railroad retirement (RRTA) taxes
OTHER
FORM refunded to you, but only if you file a tax return. were withheld, you may be able to claim a credit for the
W-2’S
W-2 Clergy and religious workers. If you aren’t subject to excess against your federal income tax. If you had more
social security and Medicare taxes, see Pub. 517, Social than one railroad employer and more than $4,630.50 in
Security and Other Information for Members of the Clergy Tier 2 RRTA tax was withheld, you also may be able to
and Religious Workers. claim a credit. See your Form 1040 or Form 1040A
Corrections. If your name, SSN, or address is incorrect, instructions and Pub. 505, Tax Withholding and
correct Copies B, C, and 2 and ask your employer to Estimated Tax.
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)

Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service