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Content

W-2 Preview
Employer's Name : Employer's FEIN : Tax Back LLC 46-0990964 Wages, Tips, other Comp Federal Income Tax Withheld Box 2 Social Security Wages Employer's Address : 243 Two Pond Loop Employer's ZIP Code : 29456 Soc Sec Tax Withheld Box 4 Medicare Wages Medicare Tax Withheld State Wages, Tips, Etc State Income Tax Local Wages, Tips, Etc Local Income Tax Soc Sec Tips Box 7 Allocated Tips Box 8 Adv EIC Box 9 Dep Care Box 10 NQ Plan Box 11 Ladson SC

Earnings Summary

Box 12

Box 1 Birr, Dennis A Gross Pay Reported W-2 Wages/Tax Chalker, Anthony Gross Pay Reported W-2 Wages/Tax Fusco, Andrew Gross Pay Reported W-2 Wages/Tax Johnson, Ashley N Gross Pay Reported W-2 Wages/Tax Lyles, David Gross Pay Reported W-2 Wages/Tax Mardany, Sidney Gross Pay Reported W-2 Wages/Tax 853.25 853.25 612.00 612.00 11526.18 11526.18 370.00 370.00 36.00 36.00 37.50 37.50

Box 3

Box 5

Box 6

Box 16

Box 17

Box 18

Box 19

Box 13

Box 14

SSN : 248-73-1726 37.50 37.50 37.50 37.50

Address : 7963 Ruskin Rd 37.50 37.50

North Charleston SC 29418

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

0.00

2.33 SSN : 647-01-4547

0.54

Address : 6717 Bent Creek Drive 36.00 36.00 36.00 36.00

North Charleston SC 29420

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

0.00

36.00 36.00

2.23 SSN : 114-42-9802

0.52

Address : 20 Larry St Apt 3D 370.00 370.00

Summerville SC 29485

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

4.54

370.00 370.00

22.94

370.00 370.00

5.37

4.23 Noth Charleston SC 29420

SSN : 609-44-8571 11526.18 11526.18 11526.18 11526.18

Address : 8439 Dorchester Rd Apt 421 11526.18 11526.18

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

294.73

714.62

167.13

281.54 Summerville SC 29485

SSN : 248-43-1885 612.00 612.00 612.00 612.00

Address : 125 Heart Pine Circle 612.00 612.00

0.00

37.94

8.87

SSN : 227-86-5003 853.25 853.25 853.25 853.25

Address : 8410 Dorchester Rd 853.25 853.25

North Charleston SC 29418

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

4.82

52.90

12.37

10.09

Company: Tax Back LLC Year : 2013

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W-2 Preview
Employer's Name : Employer's FEIN : Tax Back LLC 46-0990964 Wages, Tips, other Comp Federal Income Tax Withheld Box 2 Social Security Wages Employer's Address : 243 Two Pond Loop Employer's ZIP Code : 29456 Soc Sec Tax Withheld Box 4 Medicare Wages Medicare Tax Withheld State Wages, Tips, Etc State Income Tax Local Wages, Tips, Etc Local Income Tax Soc Sec Tips Box 7 Allocated Tips Box 8 Adv EIC Box 9 Dep Care Box 10 NQ Plan Box 11 Ladson SC

Earnings Summary

Box 12

Box 1 MAY, JACQUELIN Gross Pay Reported W-2 Wages/Tax SELDENRIGHT, JOSHUA S Gross Pay Reported W-2 Wages/Tax Shea, Michael Gross Pay Reported W-2 Wages/Tax Sintay, Tammy Gross Pay Reported W-2 Wages/Tax TEIBERT, TIFFANY M Gross Pay Reported W-2 Wages/Tax FEDERAL TOTALS Gross Pay Reported W-2 Wages/Tax STATE AND LOCAL TOTALS 44.00 44.00 360.00 360.00 1525.25 1525.25 160.00 160.00 729.74 729.74

Box 3

Box 5

Box 6

Box 16

Box 17

Box 18

Box 19

Box 13

Box 14

SSN : 579-64-2691 729.74 729.74 729.74 729.74

Address : 246 TWO POND LOOP 729.74 729.74

LADSON SC 29456

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

39.59

45.24

10.58

23.85 CHARLESTON SC 29418

SSN : 282-96-4353 160.00 160.00 160.00 160.00

Address : 4650 PURCELL DRIVE APT 2407 160.00 160.00

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

0.00

9.92

2.32

SSN : 208-58-8499 1525.25 1525.25 1525.25 1525.25

Address : 209 General Dennis Drive 1525.25 1525.25

Summerville SC 29483

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

0.00

94.57

22.12

SSN : 155-60-4510 360.00 360.00 360.00 360.00

Address : 243 Two Pond Loop 360.00 360.00

Ladson SC 29456

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N

10.62

22.32

5.22

8.49 NORTH CHARLESTON SC

SSN : 248-93-2565 44.00 44.00

0.00

2.73

Address : 309 DORCHESTER MANOR BLVD 29420 44.00 44.00 44.00 0.64 44.00

SIT : SC Local : Stat EE - N Ret plan - N 3PSP - N Stat EE - 0 Ret plan - 0 3PSP - 0

W3 Kind of Employer: None apply 16253.92 16253.92 16253.92 354.30 16253.92

1007.74

16253.92 16253.92

235.68

Company: Tax Back LLC Year : 2013

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W-2 Preview
Employer's Name : Employer's FEIN : Tax Back LLC 46-0990964 Wages, Tips, other Comp Federal Income Tax Withheld Box 2 Social Security Wages Employer's Address : 243 Two Pond Loop Employer's ZIP Code : 29456 Soc Sec Tax Withheld Box 4 Medicare Wages Medicare Tax Withheld State Wages, Tips, Etc State Income Tax Local Wages, Tips, Etc Local Income Tax Soc Sec Tips Box 7 Allocated Tips Box 8 Adv EIC Box 9 Dep Care Box 10 NQ Plan Box 11 Ladson SC

Earnings Summary

Box 12

Box 1 SC SIT

Box 3

Box 5

Box 6

Box 16 16253.92

Box 17 328.20

Box 18

Box 19

Box 13

Box 14

REPORT ABBREVIATIONS Soc Sec Tax Medicare Tax State Income Tax Local Income Tax Adv EIC Dep Care NQ Plan Stat EE - Y Ret plan - Y 3PSP - Y Social Security Tax Withheld Medicare Tax Withheld State Income Tax Withheld Local Income Tax Withheld Advanced Earned Income Credit payments Dependent Care Benefits Distributions to the employee from a non-qualified pension plan or a 457 plan Indicates a "Statutory Employee" whose earnings are not subject to Federal Income Tax withholding Indicates that the employee participated in a retirement plan. Indicates that the W-2 was issued by a Third Party Sick Pay payer or that the employee received sick pay payments made by a third party. The state for which income tax was withheld Indicates that the employee is exempt from state income tax. The local jurisdiction for which income tax was withheld This warning will appear in a wage column when the employee's adjusted gross wage does not

BOX 12 A. Uncollected social security or RRTA tax on tips. B. Uncollected Medicare tax on tips C. Cost of taxable group-term life insurance over $50,000 D. Section 401 (k) contributions including the amount deferred under a SIMPLE retirement account that is part of a 401 (k) arrangement E. Section 403(b) contributions F. Section 408 (k)(6) contributions G. Section 457 (b) contributions H. Section 501 ( c ) (18)(D) contributions J. Nontaxable sick pay (not included in boxes 1, 3, or 5) K. 20% excise tax on excess golden parachute payments Does not apply to this payroll product L. Substantiated employee business expense reimbursements (non-taxable) M. Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (former employees only) N. Uncollected Medicare tax on cost of taxable group-term life insurance over $50,000 (former employees only) P. Excludable moving expense reimbursements paid directly to employee Q. Military employee basic housing, subsistence and combat zone compensation Does not apply to this payroll product R. Employer contributions to a medical savings account (MSA) UI/WF/SWF NJ VPDI PPN NJ DI RISDI CA DI CA VPDI Voluntary plan disability insurance (NY and HI) SUI IMA 414H AUTO FLI PICKUP S-CORP SEP

BOX 14 414H Pension Contributions Company car - personal use NJ Family Leave Insurance Mandatory Retirement Contributions (414H in Maryland) S-Corp Earnings Simplified pension contributions for subject states - AL, AR, CA, KY, MA, NC, NJ NJ State Unemployment Insurance Voluntary plan disability insurance (NJ) NJ VPDI Insurance Number NJ State Disability Insurance RI State Disability Insurance CA State Disability Insurance Voluntary plan disability insurance (CA)

SIT: xx SIT: Exempt Local: xxxxxxxxxx Caution! OOB

SUI tax withheld from employee (AK and PA) Individual Medical Account (MO)

Company: Tax Back LLC Year : 2013

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W-2 Preview
Employer's Name : Employer's FEIN : Tax Back LLC 46-0990964 Wages, Tips, other Comp Federal Income Tax Withheld Box 2 Social Security Wages Employer's Address : 243 Two Pond Loop Employer's ZIP Code : 29456 Soc Sec Tax Withheld Box 4 Medicare Wages Medicare Tax Withheld State Wages, Tips, Etc State Income Tax Local Wages, Tips, Etc Local Income Tax Soc Sec Tips Box 7 Allocated Tips Box 8 Adv EIC Box 9 Dep Care Box 10 NQ Plan Box 11 Ladson SC

Earnings Summary

Box 12

Box 1

Box 3

Box 5

Box 6

Box 16

Box 17

Box 18

Box 19 MMIPAA HOUSNG PKNGPASS TRPASS C WAGE YT ZN

Box 13

Box 14

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

S. Section 408(p) employee salary reduction contributions to a simple retirement account. However, if the simple is a part of a 401(k) arrangement, the amount is reported using code D T. Employer-providing adoption benefits for the amount paid or expenses incurred by an employer under an adoption assistance program. Also includes benefits from pre-tax contributions made by an employee to a Section 125 adoption plan account. V. Income from the exercise of non-statutory stock options W. Employer contributions to Health Savings Account Y. 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) plan BB. Designated Roth contributions under a section 403(b) plan CC. HIRE Act exempt wages DD. Cost of Employer Sponsored Health Care EE. Designated Roth contributions under a governmental section 457(b) plan

Medical Malpractice Insurance Premium Assessment Taxable housing earnings or clergy housing earnings Parking Pass (pre-tax) Transit Pass (pre-tax) Commodity Wage Non-Qual Def Comp - Distribution (PA SIT) Non-Qual Def Comp - Deferral (PA SIT)

Company: Tax Back LLC Year : 2013

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