XXX-XX-1785 18704.00 116.62 18704.00 1159.65 18704.00 271.21 Houston TX 77084
XXX-XX-1785 18704.00 116.62 18704.00 1159.65 18704.00 271.21 Houston TX 77084
XXX-XX-1785 18704.00 116.62 18704.00 1159.65 18704.00 271.21 Houston TX 77084
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
47-5046954 18704.00 116.62
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
ADCOM WIRELESS INC 18704.00 1159.65
5 Medicare wages and tips 6 Medicare tax withheld
3402 LONGHORN DR 18704.00 271.21
7 Social security tips 8 Allocated tips
HOUSTON TX 77084
d Control number 9 10 Dependent care benefits
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
C
o
FREDY CASTILLO d
e L 13430.00
13 Statutory Retirement Third-party 12b
3402 LONGHORN DR employee plan sick pay C
o
d
e
12d
C
o
d
e
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
C
o
FREDY CASTILLO d
e L 13430.00
13 Statutory Retirement Third-party 12b
3402 LONGHORN DR employee plan sick pay C
o
d
e
12d
C
o
d
e
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o
FREDY CASTILLO d
e L 13430.00
13 Statutory Retirement Third-party 12b
3402 LONGHORN DR employee plan sick pay C
o
d
e
12d
C
o
d
e