a Employee's social security number
573-95-3717
b Employer identification number (EIN)
c Employer's name, address, and ZIP code
, TX
e Employee's first name and initial Last name Suff.
Cristina Avila
6011 punsley dr
Katy, TX 77449
1 Wages, tips, other compensation
$4800.00
2 Federal income tax withheld
$262.40
3 Social security wages
$4800.00
4 Social security tax withheld
$297.60
5 Medicare wages and tips
$4800.00
6 Medicare tax withheld
$69.60
7 Social security tips
$0.00
10 Dependent care benefits
$0.00
11 Nonqualified plans
$0.00
12a See instructions for box 12
13
☐ Statutory employee
☐ Retirement plan
☐ Third-party sick pay
17 State income tax
$0.00
Form W-2 • 2026 • OMB No. 1545-0008