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Personal Info
Taxpayer
Spouse
First Name
First Name
Middle Initial
Middle Initial
Last Name
Last Name
Jr.,Sr.,Etc.
Jr.,Sr.,Etc.
Birth Date
Birth Date
Soc. Sec. Num.
Soc. Sec. Num.
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Personal Info (Continued)
Enter Mailing Address and Home Phone
Address
Apt. No.
City
Zip Code
Home Phone
State
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Taxpayer
Spouse
Occupation
Occupation
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Extension
Extension
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W2 Info
Boxes b-c
b Employer's ID No.
c Employer's
Name
Address
City
State
Zip
Boxes 1-11 (Taxpayer)
1
Wages
7
Soc Sec Tips
2
Federal Tax W/H
8
Allocated Tips
3
Soc Sec Wages
9
Advanced EIC
4
Soc Sec Tax W/H
10
Dependent Care
5
Medicare Wages
11
Nonqual Plan
6
Medicare Tax W/H
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