B  Employer identification number (EIN) 

                 58-5648648

22222 

OMS No. 1545-0008 

32,000.00

1 Wages, tips, other compensation 

3425.00

2 Federal income tax withheld 

c Employer's name, address, and ZIP code 

Dunkin Donuts
Hwy 5
Douglasville, GA 30134

252-02-6874

d Employee Social Security Number 

32,000.00

3 Social security wages 

32,000.00

5 Medicare wages and tips 

7 Social security tips 

9 Advance EIC payment 

1984.00

4 Social security tax withheld 

464.00

6 Medicare tax withheld 

8 Allocated tips 

10 Dependent care benefits 

12a.

e Employee's Name

Kevin Bailey
4675 Oak Town Dr.
Douglasville, GA 30135

. 	11 Nonqualified plans 

 

f Employee's address and ZIP code 
	15 State 	Employer's state 10 number 

GA

Form W-2 

32,000.00

16 State wages, tips, etc. 

17 State income tax 

950.00

18 Local wages, tips, etc. 

wage and Tax Statement 
Copy 1-For State, City, or Local Tax Department 

2010

Department of the Treasury-Internal Revenue Service