2013 W-2 and EARNINGS SUMMARY

W-2
c

Copy C for employees records.

Employee Reference Wage and Tax Statement

Dept. Corp.

Copy

2013

OMB No. 1545-0008

d Control number 0000007775 VRO

Employer use only

40165

LEA7

6483

Employers name, address, and ZIP code

MARITZ RESEARCH INC 1375 NORTH HIGHWAY DRIVE FENTON, MO 63099-0100

e/f Employees name, address, and ZIP code

DANIEL VILLICANA ORTIZ 1004 E 5TH ST APT 5 LONG BEACH, CA 90802-1672

b
1 3 5

Employers FED ID number

a Employees SSA number

43-0890097
Wages, tips, other comp.

605-78-5232
2 Federal income tax withheld

4167.48
Social security wages

308.97
4 Social security tax withheld

4167.48
Medicare wages and tips

258.38
6 Medicare tax withheld

4167.48
7
9

60.43
8 Allocated tips 10 Dependent care benefits 12a See instructions for box 12 12b 12c 12d 13 Stat emp. Ret. plan 3rd party sick pay

Social security tips

11 Nonqualified plans 14 Other

41.67 CA SDI

DANIEL VILLICANA ORTIZ 1004 E 5TH ST APT 5 LONG BEACH, CA 90802-1672

15 State Employers state ID no. 16 State wages, tips, etc.

232-4800 CA 17 State income tax

19 Local income tax

4167.48
18 Local wages, tips, etc. 20 Locality name
2011 ADP, INC.

Social Security Number: 605-78-5232 Taxable Marital Status: SINGLE Exemptions/Allowances: Federal: 0 State: 0 Local: 0

PAGE 01 OF 01
1 3 5

Wages, tips, other comp.

2 Federal income tax withheld

1 3 5

Wages, tips, other comp.

2 Federal income tax withheld

1 3 5

Wages, tips, other comp.

2 Federal income tax withheld

4167.48
Social security wages

308.97
4 Social security tax withheld

4167.48
Social security wages

308.97
4 Social security tax withheld

4167.48
Social security wages

308.97
4 Social security tax withheld

4167.48
Medicare wages and tips

258.38
6 Medicare tax withheld

4167.48
Medicare wages and tips

258.38
6 Medicare tax withheld

4167.48
Medicare wages and tips

258.38
6 Medicare tax withheld

4167.48
d Control number 0000007775 VRO c
Dept. 40165 Corp.

60.43
Employer use only

4167.48
d Control number 0000007775 VRO c
Dept. 40165 Corp.

60.43
Employer use only

4167.48
d Control number 0000007775 VRO c
Dept. 40165 Corp.

60.43
Employer use only

LEA7

6483

LEA7

6483

LEA7

6483

Employers name, address, and ZIP code

Employers name, address, and ZIP code

Employers name, address, and ZIP code

MARITZ RESEARCH INC 1375 NORTH HIGHWAY DRIVE FENTON, MO 63099-0100

MARITZ RESEARCH INC 1375 NORTH HIGHWAY DRIVE FENTON, MO 63099-0100

MARITZ RESEARCH INC 1375 NORTH HIGHWAY DRIVE FENTON, MO 63099-0100

b 7
9

Employers FED ID number

a Employees SSA number

43-0890097
Social security tips

605-78-5232

b 7
9

Employers FED ID number

a Employees SSA number

b 7
9

Employers FED ID number

a Employees SSA number

43-0890097
Social security tips

605-78-5232

43-0890097
Social security tips

605-78-5232
8 Allocated tips 10 Dependent care benefits 12a 12b 12c 12d 13 Stat emp. Ret. plan 3rd party sick pay

8 Allocated tips 10 Dependent care benefits 12a See instructions for box 12 12b 12c 12d 13 Stat emp. Ret. plan 3rd party sick pay

8 Allocated tips 10 Dependent care benefits 12a 12 12b 12c 12d 13 Stat emp. Ret. plan 3rd party sick pay

11 Nonqualified plans 14 Other

41.67 CA SDI

11 Nonqualified plans 14 Other

41.67 CA SDI

11 Nonqualified plans 14 Other

41.67 CA SDI

e/f Employees name, address and ZIP code

e/f Employees name, address and ZIP code

e/f Employees name, address and ZIP code

DANIEL VILLICANA ORTIZ 1004 E 5TH ST APT 5 LONG BEACH, CA 90802-1672

15 State Employers state ID no. 16 State wages, tips, etc. 232-4800 8 CA 4167.48 17 State income tax 19 Local income tax 18 Local wages, tips, etc. 20 Locality name

DANIEL VILLICANA ORTIZ 1004 E 5TH ST APT 5 LONG BEACH, CA 90802-1672

15 State Employers state ID no. 16 State wages, tips, etc. 232-4800 8 CA 4167.48 17 State income tax 19 Local income tax 18 Local wages, tips, etc. 20 Locality name

DANIEL VILLICANA ORTIZ 1004 E 5TH ST APT 5 LONG BEACH, CA 90802-1672

15 State Employers state ID no. 16 State wages, tips, etc. 232-4800 8 CA 4167.48 17 State income tax 19 Local income tax 18 Local wages, tips, etc. 20 Locality name

Federal

W-2

OMB No. 1545-0008 Copy B to be filed with employees Federal Income Tax Return.

Filing Copy Wage and Tax Statement

2013

W-2

OMB No. 1545-0008 Copy 2 to be filed with employees State Income Tax Return.

CA. State Filing Copy Wage and Tax Statement

City

2013

W-2

No. 1545-0008 Copy 2 to be filed with employees City or Local Income Tax Return.

or Local Filing Copy Wage and Tax Statement OMB

2013

Instructions for Employee

Box 1. Enter this amount on the wages line of your tax return. Box 2. Enter this amount on the federal income tax withheld line of your tax return. Box 5. This amount may be required to be entered on Form 8959. See Form 1040 instructions to determine if you are required to complete Form 8959. Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips shown in Box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare wages and tips above $200,000. Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on your tax return, see your Form 1040 instructions. You must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with your income tax return to report at least the allocated tip amount unless you can prove a smaller amount with adequate records. If you have records that show the actual amount of tips you received, report that amount even if it is more or less than the allocated tips. On Form 4137 you will figure the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you must report as income and on other tips you did not report to your employer. By filing Form 4137, your social security tips will be credited to your social security record (used to figure your benefits). Box 10. This amount is the total dependent care benefits that your employer paid to you or incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over $5,000 is also included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to compute any taxable and nontaxable amounts. Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified deferred compensation or nongovernmental section 457(b) plan or (b) included in box 3 and/or 5 if it is a prior year deferral under a nonqualified or section 457(b) plan that became taxable for social security and Medicare taxes this year because there is no longer a substantial risk of forfeiture of your right to the deferred amount. This box should not be used if you had a deferral and a distribution in the same calendar year. If this happens and you are or will be age 62 by the end of the calendar year, your employer should file Form SSA-131 with the Social Security Administration and give you a copy. Box 12. The following list explains the codes shown in box 12. You may need this information to complete your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE) under all plans are generally limited to a total of $17,500 ($12,000 if you only have SIMPLE plans; $20,500 for section 403(b) plans if you qualify for the 15-year rule explained

in Pub. 571). Deferrals under code G are limited to $17,500. Deferrals under code H are limited to $7,000. However, if you were at least age 50 in 2013, your employer may have allowed an additional deferral of up to $5,500 ($2,500 for section 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is not subject to the overall limit on elective deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years before you reach retirement age. Contact your plan administrator for more information. Amounts in excess of the overall elective deferral limit must be included in income. See the "Wages, Salaries, Tips, etc." line instructions for Form 1040. Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension contribution for a prior year(s) when you were in military service. To figure whether you made excess deferrals, consider these amounts for the year shown, not the current year. If no year is shown, the contributions are for the current year. AUncollected social security or RRTA tax on tips. Include this tax on Form 1040. See "Other Taxes" in the Form 1040 instructions. BUncollected Medicare tax on tips. Include this tax on Form 1040. See "Other Taxes" in the Form 1040 instructions. CTaxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to social security wage base), and 5) DElective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals under a SIMPLE retirement account that is part of a section 401(k) arrangement. EElective deferrals under a section 403(b) salary reduction agreement FElective deferrals under a section 408(k)(6) salary reduction SEP GElective deferrals and employer contributions (including nonelective deferrals) to a section 457(b) deferred compensation plan HElective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See "Adjusted Gross Income" in the Form 1040 instructions for how to deduct. JNontaxable sick pay (information only, not included in boxes 1, 3, or 5) K20% excise tax on excess golden parachute payments. See "Other Taxes" in the Form 1040 instructions. LSubstantiated employee business expense reimbursements (nontaxable) MUncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (former employees only). See "Other Taxes" in the Form 1040 instructions. NUncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former employees only). See "Other Taxes" in the Form 1040 instructions. PExcludable moving expense reimbursements paid directly to employee (not included in boxes 1, 3, or 5)

QNontaxable combat pay. See the instructions for Form 1040 or Form 1040A for details on reporting this amount. REmployer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and Long-Term Care Insurance Contracts. S Employee salary reduction contributions under a section 408(p) SIMPLE plan (not included in box 1) TAdoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to compute any taxable and nontaxable amounts. Vlncome from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to social security wage base), and 5). See Pub. 525 and instructions for Schedule D (Form 1040) for reporting requirements. WEmployer contributions (including amounts the employee elected to contribute using a section 125 (cafeteria) plan) to your health savings account. Report on Form 8889, Health Savings Accounts (HSAs). YDeferrals under a section 409A nonqualified deferred compensation plan Zlncome under section 409A on a nonqualified deferred compensation plan. This amount is also included in box 1. It is subject to an additional 20% tax plus interest. See "Other Taxes" in the Form 1040 instructions. AADesignated Roth contributions under a section 401(k) plan BBDesignated Roth contributions under a section 403(b) plan DDCost of employer-sponsored health coverage. The amount reported with Code DD is not taxable. EEDesignated Roth contributions under a governmental section 457(b) plan. This amount does not apply to contributions under a tax-exempt organization section 457(b) plan. Box 13. If the "Retirement plan" box is checked, special limits may apply to the amount of traditional IRA contributions you may deduct. Box 14. Employers may use this box to report information such as state disability insurance taxes withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income, educational assistance payments, or a member of the clergy's parsonage allowance and utilities. Railroad employers use this box to report RRTA compensation, Tier I tax, Tier II tax, Medicare tax and Additional Medicare Tax. Note. Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax return. However, to help protect your social security benefits, keep Copy C until you begin receiving social security benefits, just in case there is a question about your work record and/or earnings in a particular year.

Department of the Treasury - Internal Revenue Service

NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS.
This information is being furnished to the Internal Revenue Service. 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. IMPORTANT NOTE:
In order to insure efficient processing, attach this W-2 to your tax return like this (following agency instructions):

Notice to Employee
Do you have to file? Refer to the Form 1040 Instructions to determine if you are required to file a tax return. Even if you do not have to file a tax return, you may be eligible for a refund if box 2 shows an amount or if you are eligible for any credit. Earned income credit (EIC). You may be able to take the EIC for 2013 if your adjusted gross income (AGI) is less than a certain amount. The amount of the credit is based on income and family size. Workers without children could qualify for a smaller credit. You and any qualifying children must have valid social security numbers (SSNs). You cannot take the EIC if your investment income is more than the specified amount for 2013 or if income is earned for services provided while you were an inmate at a penal institution. For 2013 income limits and more information, visit [Link]/eitc. Also see Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to you, but only if you file a tax return. Clergy and religious workers. If you are not subject to social security and Medicare taxes, see Pub. 517, Social Security and Other Information for Members of the Clergy and Religious Workers. Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your employer to correct your employment record. Be sure to ask the employer to file Form W-2c, Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of Form W-2c from your employer for all corrections made so you may file them with your tax return. If your name and SSN are correct but are not the same as shown on your social security card, you should ask for a new card that displays your correct name at any SSA office or by calling 1-800-772-1213. You also may visit the SSA at [Link]. Cost of employer-sponsored health coverage (if such cost is provided by the employer). The reporting in box 12, using code DD, of the cost of employer-sponsored health coverage is for your information only. The amount reported with code DD is not taxable. Credit for excess taxes. If you had more than one employer in 2013 and more than $7,049.40 in social security and/or Tier I railroad retirement (RRTA) taxes were withheld, you may be able to claim a credit for the excess against your federal income tax. If you had more than one railroad employer and more than $3,709.20 in Tier II RRTA tax was withheld, you also may be able to claim a credit. See your Form 1040 or Form 1040A instructions and Pub. 505, Tax Withholding and Estimated Tax.

TAX RETURN

THIS FORM W-2

OTHER W-2S

Department of the Treasury - Internal Revenue Service

Department of the Treasury - Internal Revenue Service

Department of the Treasury - Internal Revenue Service