Copy B -- To Be Filed With Employee's 41-1628061 Copy 2 -- To Be Filed With Employee's State, 41-1628061

FEDERAL Tax Return OMB No. 1545-0008 City, or Local Income Tax Return. OMB No. 1545-0008
a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld
584.86 28.77 584.86 28.77
549-83-4298 549-83-4298
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
b Employer ID number (EIN) 584.86 36.26 b Employer ID number (EIN) 584.86 36.26
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
35-1984435 35-1984435
584.86 8.48 584.86 8.48
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
ELWOOD STAFFING SERVICES, INC. ELWOOD STAFFING SERVICES, INC.
P.O. BOX 1024 P.O. BOX 1024
COLUMBUS, IN 47202-1024 COLUMBUS, IN 47202-1024

d Control number d Control number

Online Online
e Employee's name, address, and ZIP code Suff. e Employee's name, address, and ZIP code Suff.
AARON BAERRY AARON BAERRY
339 7TH ST. 339 7TH ST.
ROGUE RIVER, OR 97537 ROGUE RIVER, OR 97537

7 Social security tips 8 Allocated tips 9 Verification Code 7 Social security tips 8 Allocated tips 9 Verification Code

0.00 0.00
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 10 Dependent care benefits 11 Nonqualified plans 12a Code

13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code

OR WCOMP 0.72 OR WCOMP 0.72

Retirement plan 12c Code Retirement plan 12c Code

Third-party sick pay 12d Code Third-party sick pay 12d Code

OR 1587936-4 584.86 33.03 OR 1587936-4 584.86 33.03

15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement

2018 Dept. of the Treasury -- IRS Form W-2 Wage and Tax Statement
2018 Dept. of the Treasury -- IRS
This information is being furnished to the Internal Revenue Service

Copy C -- For EMPLOYEE'S RECORDS 41-1628061 Copy 2 -- To Be Filed With Employee's State, 41-1628061
(See Notice to Employee on back of Copy B.) OMB No. 1545-0008 City, or Local Income Tax Return. OMB No. 1545-0008
a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld

549-83-4298 584.86 28.77 549-83-4298 584.86 28.77

3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
b Employer ID number 584.86 36.26 b Employer ID number 584.86 36.26
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
35-1984435 35-1984435
584.86 8.48 584.86 8.48
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code

ELWOOD STAFFING SERVICES, INC. ELWOOD STAFFING SERVICES, INC.

P.O. BOX 1024 P.O. BOX 1024
COLUMBUS, IN 47202-1024 COLUMBUS, IN 47202-1024

d Control number d Control number

Online Online
e Employee's name, address, and ZIP code Suff. e Employee's name, address, and ZIP code Suff.

AARON BAERRY AARON BAERRY

339 7TH ST. 339 7TH ST.
ROGUE RIVER, OR 97537 ROGUE RIVER, OR 97537

7 Social security tips 8 Allocated tips 9 Verification Code 7 Social security tips 8 Allocated tips 9 Verification Code

0.00 0.00
10 Dependent care benefits 11 Nonqualified plans 12a Code
10 Dependent care benefits 11 Nonqualified plans 12a Code

13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code

OR WCOMP 0.72 OR WCOMP 0.72

Retirement plan 12c Code Retirement plan 12c Code

Third-party sick pay 12d Code Third-party sick pay 12d Code

OR 1587936-4 584.86 33.03 OR 1587936-4 584.86 33.03

15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Dept. of the Treasury -- IRS Dept. of the Treasury -- IRS

Form W-2 Wage and Tax Statement
2018 Form W-2 Wage and Tax Statement
2018
This information is being furnished to the IRS. If you are required to file a tax return, a negligence
penalty or other sanction may be imposed on you if this income is taxable and you fail to report it. FORM L4UP