Cool Hand Luke
b Employer identification number (EIN) c Employers name, address, and ZIP code
71-0794409
12a See instructions for box 12
C o d e
1 Wages, tips, other compensation
2 Federal income tax withheld
WAL-MART ASSOCIATES, INC.
12b
C o d e
$ $ $ $ $
13874.83
3 Social security wages
1330.56
4 Social security tax withheld
13874.83
5 Medicare wages and tips 6 Medicare tax withheld
582.74 201.19
8 Allocated tips 10 Dependent care benefits
12c
702 SW 8TH STREET BENTONVILLE, AR 72716-0135 e Employees first name and initial Last name
C o d e
12d Suff. 12e
C o d e C o d e
13874.83
7 Social security tips 9 Advance EIC payment
00512 0512
1 of 1
ID:10108000000000000148308275
ERIC BARRAGAN 1369 COPPER GATE EL PASO, TX 79936
This information is being furnished to the Internal Revenue Service.
0.00
11 Nonqualified plans 14 Other 13 Statutory employee Retirement plan Third-party sick pay
Copy B To Be Filed With Employees FEDERAL Tax Return a Employees social security number
f Employees address and ZIP code 15 State Employers state ID number
644-26-0681
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
TX
NO #
13874.83
Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy B To Be Filed With Employee 's FEDERAL Tax Return
1 Wages, tips, other compensation 2 Federal income tax withheld
Form W-2 Wage and Tax Statement 2012 b Employer identification number (EIN) c Employers name, address, and ZIP code
71-0794409
12a
C o d e
WAL-MART ASSOCIATES, INC.
12b
C o d e
$ $ $ $ $
13874.83
3 Social security wages
1330.56
4 Social security tax withheld
13874.83
5 Medicare wages and tips 6 Medicare tax withheld
582.74 201.19
8 Allocated tips 10 Dependent care benefits
12c
702 SW 8TH STREET BENTONVILLE, AR 72716-0135 e Employees first name and initial Last name Suff.
C o d e
71-0794409
12a See instructions for box 12
C o d e
1 Wages, tips, other compensation
2 Federal income tax withheld
WAL-MART ASSOCIATES, INC.
12b
C o d e
$ $ $ $ $
13874.83
3 Social security wages
1330.56
4 Social security tax withheld
13874.83
5 Medicare wages and tips 6 Medicare tax withheld
582.74 201.19
8 Allocated tips 10 Dependent care benefits
12c
702 SW 8TH STREET BENTONVILLE, AR 72716-0135 e Employees first name and initial Last name
C o d e
12d Suff. 12e
C o d e C o d e
13874.83
7 Social security tips 9 Advance EIC payment
00512 0512
1 of 1
ID:10108000000000000148308275
ERIC BARRAGAN 1369 COPPER GATE EL PASO, TX 79936
This information is being furnished to the Internal Revenue Service.
0.00
11 Nonqualified plans 14 Other 13 Statutory employee Retirement plan Third-party sick pay
Copy B To Be Filed With Employees FEDERAL Tax Return a Employees social security number
f Employees address and ZIP code 15 State Employers state ID number
644-26-0681
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
TX
NO #
13874.83
Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy B To Be Filed With Employee 's FEDERAL Tax Return
1 Wages, tips, other compensation 2 Federal income tax withheld
Form W-2 Wage and Tax Statement 2012 b Employer identification number (EIN) c Employers name, address, and ZIP code
71-0794409
12a
C o d e
WAL-MART ASSOCIATES, INC.
12b
C o d e
$ $ $ $ $
13874.83
3 Social security wages
1330.56
4 Social security tax withheld
13874.83
5 Medicare wages and tips 6 Medicare tax withheld
582.74 201.19
8 Allocated tips 10 Dependent care benefits
12c
702 SW 8TH STREET BENTONVILLE, AR 72716-0135 e Employees first name and initial Last name Suff.
C o d e