1 of 4

W-2 Preview

Employer's Name : Tax Back LLC Employer's Address : 243 Two Pond Loop Ladson SC Employer's FEIN : 46-0990964 Employer's ZIP Code : 29456

Earnings Summary

Wages,Tips, other

Comp

Box 1

FederalIncome

TaxWithheld

Box 2

SocialSecurityWages

Box 3

SocSecTax

Withheld

Box 4

MedicareWages

Box 5

MedicareTax

Withheld

Box 6

StateWages,

Tips, Etc

Box 16

StateIncome

Tax

Box 17

LocalWages,

Tips, Etc

Box 18

LocalIncome

Tax

Box 19

Soc SecTips

Box 7Allocated

TipsBox 8

Adv EICBox 9

Dep CareBox 10

NQ PlanBox 11

Box 12

Box 13

Box 14

Birr, Dennis A SSN : 248-73-1726 Address : 7963 Ruskin Rd North Charleston SC 29418 SIT : SC Local :

Gross Pay 37.50 37.50 37.50 37.50 Reported W-2 Wages/Tax 37.50 0.00 37.50 2.33 37.50 0.54 37.50

Stat EE - NRet plan - N3PSP - N

Chalker, Anthony SSN : 647-01-4547 Address : 6717 Bent Creek Drive North Charleston SC 29420 SIT : SC Local :

Gross Pay 36.00 36.00 36.00 36.00 Reported W-2 Wages/Tax 36.00 0.00 36.00 2.23 36.00 0.52 36.00

Stat EE - NRet plan - N3PSP - N

Fusco, Andrew SSN : 114-42-9802 Address : 20 Larry St Apt 3D Summerville SC 29485 SIT : SC Local :

Gross Pay 370.00 370.00 370.00 370.00 Reported W-2 Wages/Tax 370.00 4.54 370.00 22.94 370.00 5.37 370.00 4.23

Stat EE - NRet plan - N3PSP - N

Johnson, Ashley N SSN : 609-44-8571 Address : 8439 Dorchester Rd Apt 421 Noth Charleston SC 29420 SIT : SC Local :

Gross Pay 11526.18 11526.18 11526.18 11526.18 Reported W-2 Wages/Tax 11526.18 294.73 11526.18 714.62 11526.18 167.13 11526.18 281.54

Stat EE - NRet plan - N3PSP - N

Lyles, David SSN : 248-43-1885 Address : 125 Heart Pine Circle Summerville SC 29485 SIT : SC Local :

Gross Pay 612.00 612.00 612.00 612.00 Reported W-2 Wages/Tax 612.00 0.00 612.00 37.94 612.00 8.87 612.00

Stat EE - NRet plan - N3PSP - N

Mardany, Sidney SSN : 227-86-5003 Address : 8410 Dorchester Rd North Charleston SC 29418 SIT : SC Local :

Gross Pay 853.25 853.25 853.25 853.25 Reported W-2 Wages/Tax 853.25 4.82 853.25 52.90 853.25 12.37 853.25 10.09

Stat EE - NRet plan - N3PSP - N

Company: Tax Back LLCYear : 2013

2 of 4

W-2 Preview

Employer's Name : Tax Back LLC Employer's Address : 243 Two Pond Loop Ladson SC Employer's FEIN : 46-0990964 Employer's ZIP Code : 29456

Earnings Summary

Wages,Tips, other

Comp

Box 1

FederalIncome

TaxWithheld

Box 2

SocialSecurityWages

Box 3

SocSecTax

Withheld

Box 4

MedicareWages

Box 5

MedicareTax

Withheld

Box 6

StateWages,

Tips, Etc

Box 16

StateIncome

Tax

Box 17

LocalWages,

Tips, Etc

Box 18

LocalIncome

Tax

Box 19

Soc SecTips

Box 7Allocated

TipsBox 8

Adv EICBox 9

Dep CareBox 10

NQ PlanBox 11

Box 12

Box 13

Box 14

MAY, JACQUELIN SSN : 579-64-2691 Address : 246 TWO POND LOOP LADSON SC 29456 SIT : SC Local :

Gross Pay 729.74 729.74 729.74 729.74 Reported W-2 Wages/Tax 729.74 39.59 729.74 45.24 729.74 10.58 729.74 23.85

Stat EE - NRet plan - N3PSP - N

SELDENRIGHT, JOSHUA S SSN : 282-96-4353 Address : 4650 PURCELL DRIVE APT 2407 CHARLESTON SC 29418 SIT : SC Local :

Gross Pay 160.00 160.00 160.00 160.00 Reported W-2 Wages/Tax 160.00 0.00 160.00 9.92 160.00 2.32 160.00

Stat EE - NRet plan - N3PSP - N

Shea, Michael SSN : 208-58-8499 Address : 209 General Dennis Drive Summerville SC 29483 SIT : SC Local :

Gross Pay 1525.25 1525.25 1525.25 1525.25 Reported W-2 Wages/Tax 1525.25 0.00 1525.25 94.57 1525.25 22.12 1525.25

Stat EE - NRet plan - N3PSP - N

Sintay, Tammy SSN : 155-60-4510 Address : 243 Two Pond Loop Ladson SC 29456 SIT : SC Local :

Gross Pay 360.00 360.00 360.00 360.00 Reported W-2 Wages/Tax 360.00 10.62 360.00 22.32 360.00 5.22 360.00 8.49

Stat EE - NRet plan - N3PSP - N

TEIBERT, TIFFANY M SSN : 248-93-2565 Address : 309 DORCHESTER MANOR BLVD NORTH CHARLESTON SC 29420

SIT : SC Local :

Gross Pay 44.00 44.00 44.00 44.00 Reported W-2 Wages/Tax 44.00 0.00 44.00 2.73 44.00 0.64 44.00

Stat EE - NRet plan - N3PSP - N

FEDERAL TOTALS W3 Kind of Employer: None applyGross Pay 16253.92 16253.92 16253.92 Reported W-2 Wages/Tax 16253.92 354.30 16253.92 1007.74 16253.92 235.68

Stat EE - 0Ret plan - 0

3PSP - 0STATE AND LOCAL TOTALS

Company: Tax Back LLCYear : 2013

3 of 4

W-2 Preview

Employer's Name : Tax Back LLC Employer's Address : 243 Two Pond Loop Ladson SC Employer's FEIN : 46-0990964 Employer's ZIP Code : 29456

Earnings Summary

Wages,Tips, other

Comp

Box 1

FederalIncome

TaxWithheld

Box 2

SocialSecurityWages

Box 3

SocSecTax

Withheld

Box 4

MedicareWages

Box 5

MedicareTax

Withheld

Box 6

StateWages,

Tips, Etc

Box 16

StateIncome

Tax

Box 17

LocalWages,

Tips, Etc

Box 18

LocalIncome

Tax

Box 19

Soc SecTips

Box 7Allocated

TipsBox 8

Adv EICBox 9

Dep CareBox 10

NQ PlanBox 11

Box 12

Box 13

Box 14

SC SIT 16253.92 328.20

REPORT ABBREVIATIONS

Soc Sec Tax Social Security Tax WithheldMedicare Tax Medicare Tax WithheldState Income Tax State Income Tax WithheldLocal Income Tax Local Income Tax WithheldAdv EIC Advanced Earned Income Credit paymentsDep Care Dependent Care BenefitsNQ Plan Distributions to the employee from a non-qualified

pension plan or a 457 planStat EE - Y Indicates a "Statutory Employee" whose earnings

are not subject to Federal Income Tax withholdingRet plan - Y Indicates that the employee participated in a

retirement plan.3PSP - Y Indicates that the W-2 was issued by a Third

Party Sick Pay payer or that the employeereceived sick pay payments made by a third party.

SIT: xx The state for which income tax was withheldSIT: Exempt Indicates that the employee is exempt from state

income tax.Local:xxxxxxxxxx

The local jurisdiction for which income tax waswithheld

Caution!OOB

This warning will appear in a wage column whenthe employee's adjusted gross wage does not

BOX 12A. Uncollected social security or RRTA tax on tips.B. Uncollected Medicare tax on tipsC. Cost of taxable group-term life insurance over $50,000D. Section 401 (k) contributions including the amount deferred under aSIMPLE retirement account that is part of a 401 (k) arrangementE. Section 403(b) contributionsF. Section 408 (k)(6) contributionsG. Section 457 (b) contributionsH. Section 501 ( c ) (18)(D) contributionsJ. Nontaxable sick pay (not included in boxes 1, 3, or 5)K. 20% excise tax on excess golden parachute payments Does not apply tothis payroll productL. Substantiated employee business expense reimbursements(non-taxable)M. Uncollected social security or RRTA tax on taxable cost of group-termlife insurance over $50,000 (former employees only)N. Uncollected Medicare tax on cost of taxable group-term life insuranceover $50,000 (former employees only)P. Excludable moving expense reimbursements paid directly to employeeQ. Military employee basic housing, subsistence and combat zonecompensation Does not apply to this payroll productR. Employer contributions to a medical savings account (MSA)

BOX 14

414H 414H Pension ContributionsAUTO Company car - personal useFLI NJ Family Leave InsurancePICKUP Mandatory Retirement Contributions (414H in

Maryland)S-CORP S-Corp EarningsSEP Simplified pension contributions for subject states

- AL, AR, CA, KY, MA, NC, NJUI/WF/SWF NJ State Unemployment InsuranceNJ VPDI Voluntary plan disability insurance (NJ)PPN NJ VPDI Insurance NumberNJ DI NJ State Disability InsuranceRISDI RI State Disability InsuranceCA DI CA State Disability InsuranceCA VPDI Voluntary plan disability insurance (CA)Voluntary plandisability insurance(NY and HI)SUI SUI tax withheld from employee (AK and PA)IMA Individual Medical Account (MO)

Company: Tax Back LLCYear : 2013

4 of 4

W-2 Preview

Employer's Name : Tax Back LLC Employer's Address : 243 Two Pond Loop Ladson SC Employer's FEIN : 46-0990964 Employer's ZIP Code : 29456

Earnings Summary

Wages,Tips, other

Comp

Box 1

FederalIncome

TaxWithheld

Box 2

SocialSecurityWages

Box 3

SocSecTax

Withheld

Box 4

MedicareWages

Box 5

MedicareTax

Withheld

Box 6

StateWages,

Tips, Etc

Box 16

StateIncome

Tax

Box 17

LocalWages,

Tips, Etc

Box 18

LocalIncome

Tax

Box 19

Soc SecTips

Box 7Allocated

TipsBox 8

Adv EICBox 9

Dep CareBox 10

NQ PlanBox 11

Box 12

Box 13

Box 14

balance to the accumulated taxable wage.An adjustment to an earning, deduction, or theaccumulated taxable wage may be required tobring the wages into balance.

S. Section 408(p) employee salary reduction contributions to a simpleretirement account. However, if the simple is a part of a 401(k)arrangement, the amount is reported using code DT. Employer-providing adoption benefits for the amount paid or expensesincurred by an employer under an adoption assistance program. Alsoincludes benefits from pre-tax contributions made by an employee to aSection 125 adoption plan account.V. Income from the exercise of non-statutory stock optionsW. Employer contributions to Health Savings AccountY. Deferrals under Section 409A nonqualified deferred compensation plan.Does not apply to this payroll product.Z. Income under Section 409A nonqualified deferred compensation plan.Does not apply to this payroll product.AA. Designated Roth contributions under a section 401(k) planBB. Designated Roth contributions under a section 403(b) planCC. HIRE Act exempt wagesDD. Cost of Employer Sponsored Health CareEE. Designated Roth contributions under a governmental section 457(b)plan

MMIPAA Medical Malpractice Insurance PremiumAssessment

HOUSNG Taxable housing earnings or clergy housingearnings

PKNGPASS Parking Pass (pre-tax)TRPASS Transit Pass (pre-tax)C WAGE Commodity WageYT Non-Qual Def Comp - Distribution (PA SIT)ZN Non-Qual Def Comp - Deferral (PA SIT)

Company: Tax Back LLCYear : 2013