a Employee's social security number 456-87-5432 OMB No. 1545-0008 Safe, accurate, FAST! Use IRS e ~ file Visit the IRS website at www.irs.gov/efile b Employer identification number (EIN) 33-4382966 1 Wages, tips, other compensation 30,350.00 2 Federal income tax withheld 5,002.00 c Employer's name, address, and ZIP code City of Dayton Fire and Rescue 123 Warren Street Dayton, OH 45402 3 Social security wages 30,350.00 4 Social security tax withheld 1,881.70 5 Medicare wages and tips 30,350.00 6 Medicare tax withheld 440.80 7 Social security tips 8 Allocated tips 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 d e DD 9,897.13 Joan Arc 1265 W. Riverview Avenue Dayton, OH 45402 13 Statutory employee Retirement plan Third-party sick pay ☐ ☒ ☐ 12b C o d e 14 Other 12c C o d e 12d C o d e f Employee's address and ZIP code 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 OH 1126-87021 30,350.00 1,900.00 30,350.00 758.75 DAYTN Form W-2 Wage and Tax Statement 2020 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.