FORM W-2 SUB Fillable Substitute W-2 Wage and Tax Statement
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

1 Your name 2 Employer (business name or owner's name) 3 Wages tips other compensation 4 How did you determine the amounts in 3? You must attach copies of any documents or schedules used to determine this 5 Give reason if known why a W 2 form was not furnished by employer Address amount Attach photocopy of payroll check stub(s)or other document(s) City State Zip City State Zip Phone number if known EFO00169 Employer's ID number if known Federal income tax withheld I verify that I have made efforts to contact this employer and have given this employer sufficient time to mail or Idaho income tax withheld Idaho Substitute W 2 otherwise provide this statement Phone number Social security number Social security tax withheld to verify the Idaho withholding amount(s) claimed W 2 SUB Wage and Tax Statement 20 Your signature