Copy B--To Be Filed With Employee's FEDERAL Tax Return OMB No.
OMB No. 1545-0008 Copy 2--To Be Filed With Employee's State, City, OMB No. 1545-0008
This information is being furnished to the Internal Revenue Service. or Local Income Tax Return
a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld
150-88-8348 29788.56 1692.61 150-88-8348 29788.56 1692.61
b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld
85-1992255 29788.56 1846.89 85-1992255 29788.56 1846.89
d. Control number 5. Medicare wages and tips 6. Medicare tax withheld d. Control number 5. Medicare wages and tips 6. Medicare tax withheld
M424-180625 29788.56 431.93 M424-180625 29788.56 431.93
c. Employer's name, address, and ZIP code c. Employer's name, address, and ZIP code
AB III LLC AB III LLC
2400 N Broadway St ATTN: Payroll 2400 N Broadway St ATTN: Payroll
Pittsburg, KS 66762-2619 Pittsburg, KS 66762-2619
e. Employee's name, address, and ZIP code e. Employee's name, address, and ZIP code
ZACHARIAH MARTINEZ ZACHARIAH MARTINEZ
3305 ASTOR CLOSE 108 HIDDEN FOREST CT 3305 ASTOR CLOSE 108 HIDDEN FOREST CT
FAIRLESS HILLS, PA 19030 FAIRLESS HILLS, PA 19030
7. Social security tips 8. Allocated tips 9. 7. Social security tips 8. Allocated tips 9.
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12 10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12
13. Statutory employee 14. Other 12b. Code 13. Statutory employee 14. Other 12b. Code
PASUI 20.85 PASUI 20.85
Retirement plan 12c. Code Retirement plan 12c. Code
Third-party sick pay 12d. Code Third-party sick pay 12d. Code
15. State Employer's state ID number 16. State wages, tips, etc. 17.State income tax 15. State Employer's state ID number 16. State wages, tips, etc. 17.State income tax
PA 2019 0155 29788.56 914.50 PA 2019 0155 29788.56 914.50
18. Local wages, tips, etc. 19. Local income tax 20. Locality name 18. Local wages, tips, etc. 19. Local income tax 20. Locality name
29788.56 286.72 091201-09 29788.56 286.72 091201-09
Form W-2 Wage and Tax Statement 2023 Department of the Treasury ~ Internal Revenue Service Form W-2 Wage and Tax Statement 2023 Department of the Treasury ~ Internal Revenue Service
Copy C--For EMPLOYEE'S RECORDS(See Notice to Employee.)
This information is being furnished to the Internal Revenue Service. If you are required to file a tax OMB No. 1545-0008 Copy 2--To Be Filed With Employee's State, City, OMB No. 1545-0008
return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you or Local Income Tax Return
fail to report it.
a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld
150-88-8348 29788.56 1692.61 150-88-8348 29788.56 1692.61
b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld
85-1992255 29788.56 1846.89 85-1992255 29788.56 1846.89
d. Control number 5. Medicare wages and tips 6. Medicare tax withheld d. Control number 5. Medicare wages and tips 6. Medicare tax withheld
M424-180625 29788.56 431.93 M424-180625 29788.56 431.93
c. Employer's name, address, and ZIP code c. Employer's name, address, and ZIP code
AB III LLC AB III LLC
2400 N Broadway St ATTN: Payroll 2400 N Broadway St ATTN: Payroll
Pittsburg, KS 66762-2619 Pittsburg, KS 66762-2619
e. Employee's name, address, and ZIP code e. Employee's name, address, and ZIP code
ZACHARIAH MARTINEZ ZACHARIAH MARTINEZ
3305 ASTOR CLOSE 108 HIDDEN FOREST CT 3305 ASTOR CLOSE 108 HIDDEN FOREST CT
FAIRLESS HILLS, PA 19030 FAIRLESS HILLS, PA 19030
7. Social security tips 8. Allocated tips 9. 7. Social security tips 8. Allocated tips 9.
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12 10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12
13. Statutory employee 14. Other 12b. Code 13. Statutory employee 14. Other 12b. Code
PASUI 20.85 PASUI 20.85
Retirement plan 12c. Code Retirement plan 12c. Code
Third-party sick pay 12d. Code Third-party sick pay 12d. Code
15. State Employer's state ID number 16. State wages, tips, 17.State income tax 15. State Employer's state ID number 16. State wages, tips, 17.State income tax
etc. etc.
PA 2019 0155 29788.56 914.50 PA 2019 0155 29788.56 914.50
18. Local wages, tips, etc. 19. Local income tax 20. Locality name 18. Local wages, tips, etc. 19. Local income tax 20. Locality name
29788.56 286.72 091201-09 29788.56 286.72 091201-09
Form W-2 Wage and Tax Statement Department of the Treasury ~ Internal Revenue Service Form W-2 Wage and Tax Statement Department of the Treasury ~ Internal Revenue Service
2023 2023
