Fax Completed Form To: James Brett Forgach

Tax Year:
______Employer Summary of
Form W-2 Magnetic Media
Wage Information

Please complete this form by printing or typing the appropriate figures in the boxes below. This form must be received by Wayne RESA no later than January 25th. This notice pertains to all Cyborg districts.

Fax Completed form to: James Brett Forgach

Wayne RESA

33500 Van Born Rd

P O Box 807

Wayne, Michigan 48184-2497

Fax: (734) 334-1299

Employer Summary of Form W-2 Magnetic Media Wage and Tip information

Name of Employer: / Check if MOGE:
Employer Identification Number: / Other EIN:

Total Amount of:

Number of W2 Forms
Social Security Wages
Social Security Tips / -0-
Wages Tips, Other Compensation
Federal Income Tax Withheld
Social Security Tax Withheld
Medicare Wages and Tips
Medicare Tax Withheld
Income Tax Withheld by 3rd Party

______

Authorized Signature Title Date