W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
Copy B — To Be Filed With Employee's FEDERAL Tax Return
a Employee's social security number
640-12-7065
b Employer identification number (EIN)
c Employer's name, address, and ZIP code


, TX
d Control number
e Employee's first name and initial     Last name     Suff.
Kandace Ross
17506 Greystanes Rd
Humble, TX 77346
1 Wages, tips, other compensation
$11200.00
2 Federal income tax withheld
$952.00
3 Social security wages
$11200.00
4 Social security tax withheld
$694.40
5 Medicare wages and tips
$11200.00
6 Medicare tax withheld
$162.40
7 Social security tips
$0.00
8 Allocated tips
$0.00
9
 
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
14 Other
 
15 State
TX
Employer's state ID
16 State wages
$11200.00
17 State income tax
$0.00
18 Local wages
$0.00
Form W-2 • 2026 • OMB No. 1545-0008
W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
Copy C — For EMPLOYEE'S RECORDS
a Employee's social security number
640-12-7065
b Employer identification number (EIN)
c Employer's name, address, and ZIP code


, TX
d Control number
e Employee's first name and initial     Last name     Suff.
Kandace Ross
17506 Greystanes Rd
Humble, TX 77346
1 Wages, tips, other compensation
$11200.00
2 Federal income tax withheld
$952.00
3 Social security wages
$11200.00
4 Social security tax withheld
$694.40
5 Medicare wages and tips
$11200.00
6 Medicare tax withheld
$162.40
7 Social security tips
$0.00
8 Allocated tips
$0.00
9
 
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
14 Other
 
15 State
TX
Employer's state ID
16 State wages
$11200.00
17 State income tax
$0.00
18 Local wages
$0.00
Form W-2 • 2026 • OMB No. 1545-0008
W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
Copy 2 — To Be Filed With Employee's State/Local Tax Return
a Employee's social security number
640-12-7065
b Employer identification number (EIN)
c Employer's name, address, and ZIP code


, TX
d Control number
e Employee's first name and initial     Last name     Suff.
Kandace Ross
17506 Greystanes Rd
Humble, TX 77346
1 Wages, tips, other compensation
$11200.00
2 Federal income tax withheld
$952.00
3 Social security wages
$11200.00
4 Social security tax withheld
$694.40
5 Medicare wages and tips
$11200.00
6 Medicare tax withheld
$162.40
7 Social security tips
$0.00
8 Allocated tips
$0.00
9
 
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
14 Other
 
15 State
TX
Employer's state ID
16 State wages
$11200.00
17 State income tax
$0.00
18 Local wages
$0.00
Form W-2 • 2026 • OMB No. 1545-0008
Generated Jun 22, 2026 at 10:28 AM • Censorium Payroll