PAGE 1

2021 W-2 and EARNINGS SUMMARY

W- 2
Em oyee Reference Co

2 21
This blue section is your Earnings Summary which provides more detailed
Wage and Tax () information on lhe generation of your W-2 statement. The reverse side
Statement 0MB No. 1545-0008 includes instructions and other general information.
CllfJ>. Employer use only
T 1238
c Employer's name, address, and ZIP code
AMAZON COM SERVICES LLC
PO BOX 80726
SEATTLE WA 98108

1. Your Gross Pay was adjusted as follows to produce yourW-2 Statement.

Batch #02708
Wages, Tips, other Social Security Medicare NY. StateWages,
e/1 Employee's name, address, and ZIP code Compensation Wages Wages Tips, Etc.
Box 1 ofW-2 Box 3 ofW-2 Box 5 ofW-2 Box 16ofW-2
GBOLAHAN A AGBE
265 LOCKMAN AVENUE Gross Pay 40,073.03 40,073.03 40,073.03 40,073.03
STATEN ISLAND NY 10303 Plus GTL (C-Box 12) 54.43 54.43 54.43 54.43
Reported W-2 Wages 40,127.46 40,127.46 40,127.46 40,127.46
b Employer's FED ID number a Employee's SSA number
82-0544687 XXX-XX-0379
Wages, tips, other comp. 2 Federal income tax withheld
40127.46 3042.20
3 Social security wages 4 Social security tax withheld
40127.46 2487.90
5 Medicare wages and tips 6 Medicare tax withheld
40127.46 581.85
7 Social security tips 8 Allocated tips

1 O Dependent care benefits 2. Employee Name and Address.

GBOLAHAN A AGBE
14 Other 265 LOCKMAN AVENUE
29.50 SDI
3950.30 AFTAX STATEN ISLAND NY 10303
13 Stat emp Ret:x'an rd party sick pa

15 State Employer's stale ID no. 16 Stale wages, tips, etc.

NY 2-0544687 40127.46
17 State income tax 18 local wages, tips, etc.
1689.23 40127.46
19 local income tax 20 locality name C 2022 ADP, Inc.
1196 .86 NYC RES
· ···-·---··--···- ____________ ..___., ____--------~---�------�r�----- _ ---------� Fold aiict Detach H�re--. ---·�~·------ -·-··,--·----·-----·-·------�-w-----�--�------·--- --·
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Wages, tips, other comp. 2 Federal income tax withheld Wages, tips, other comp. 2 Federal income tax withheld f 1 Wages, tips, other comp. 2 Federal income tax withheld
40127.46 3042.20 40127.46 3042.20 40127.46 3042.20
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld I 3 Social security wages 4 Social security tax withheld
I
40127.46 2487.90 40127.46 2487.90
401i�"."46
I 40127.46 2487.90
5 Medicare wag 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld I 5 Medicare wages and lips 6 Medicare tax withheld
581.85 40127.46 581.85 I
40127.46

I
581.85

I
I
d Control number Dept COfJ>. Employer use only d Control number Dept Corp. Employer use only I d Control number Dept COfJ>. Employer use only
:
213047 LOS2/MK 129900 T 1238 213047 LOS2/MK 129900 T 1238 I 213047 LOS2/MK 129900 T 1238
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code I C Employer's name, address, and ZIP code
AMAZON COM SERVICES LLC AMAZON COM SERVICES LLC I
AMAZON COM SERVICES LLC
PO BOX 80726 PO BOX 80726 PO BOX 80726
SEATTLE WA 98108 SEATTLE WA 98108 SEATTLE WA 98108
I

b Employer's FED ID number I b Employer's FED ID number a Employ�e_'_s SSA number b Employer's FED ID number a Employee's SSA number
_
82-0544687 82-05446 87 XXX-XX-0379 82-0544687 XXX-XX-0379
7 Social security tips 8 Allocated tips Social security tips Allocated tips

18
7

10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 12a

C 54.43 C1 54.43
14 Other 1240.97 14 Other 12b AA 1240.97 14 Other 12bAA
I 1240.97
12c I 12c
29.50 SDI 29.50 SDI 29.50 SDI I
3950.30 AFTAX 3950.30 AFTAX 12 I 3950.30 AFTAX 12a
party sick pay
I
13 Stal emp. Rel plan 3rd party sict pay I
I
13 Stal emp et i•• rd party sick pa
I -r ,r r
I
e/1 Employee's name, address and ZIP code ell Employee's name, address and ZIP code e/1 Employee's name, address and ZIP code
GBOLAHAN A AGBE I GBOLAHAN A AGBE
265 LOCKMAN AVENUE I 265 LOCKMAN AVENUE
1
STATEN ISLAND NY 10303 STATEN ISLAND NY 10303

15 Stale mployer's state ID no. 16 State wages, tips, etc.

�
NY 2-05446 87 40127.46
17 Stale income tax 18 local wages, tips, etc.
1689.23 40127.46
19 Local income tax 20 Locality name
1196.86 NYC RES

2021
NY.State Filing Copy

2021 2021 W-2 Wage and Tax

Statement Jl,MB No
Copy 2 to be filed with empl0)'1'0's State Income Tax R rn.
1545-0008