c Employer’s name, address and ZIP code c Employer’s name, address and ZIP code
OASIS OUTSOURCING V INC OASIS OUTSOURCING V INC
2054 VISTA PARKWAY STE 300 2054 VISTA PARKWAY STE 300
WEST PALM BEACH FL 33411 WEST PALM BEACH FL 33411

7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9

10 Dependent care benefits 11 Nonqualified plans 12a 10 Dependent care benefits 11 Nonqualified plans 12a

Code

Code
12b 12c 12d 12b 12c 12d
Code

Code
Code

Code
Code

Code
13 Statutory Retirement Third-party 14 Other 13 Statutory Retirement Third-party 14 Other
employee plan sick pay employee plan sick pay

e Employee’s name, address and ZIP code e Employee’s name, address and ZIP code
MARY GRACE TAMAYO MARY GRACE TAMAYO
7 7
2510 NELSON AVE 2510 NELSON AVE
BOYNE FALLS MI 49713 BOYNE FALLS MI 49713

2016 2016
15 State Employer’s state I.D. no. 16 State wages, tips, etc. 15 State Employer’s state I.D. no. 16 State wages, tips, etc.

MI 65-0786772 1960.18 MI 65-0786772 1960.18
W-2 W-2
Form

Form
Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc.

Copy C For EMPLOYEE’S 59.36 Copy B To Be Filed With 59.36
RECORDS (See Notice to Employee’s FEDERAL Tax
Employee on back of Copy B.) Return.
This information is being furnished to the This information is being furnished to the
Internal Revenue Service. If you are required 19 Local income tax 20 Locality name Internal Revenue Service. 19 Local income tax 20 Locality name
to file a tax return, a negligence penalty or
other sanction may be imposed on you if this
income is taxable and you fail to report it.

Department of the Treasury – Department of the Treasury –
Internal Revenue Service Internal Revenue Service

OMB Noxxx-xxx-xxxx OMB Noxxx-xxx-xxxx
d Control Number 1 Wages, tips, other compensation 2 Federal income tax withheld d Control Number 1 Wages, tips, other compensation 2 Federal income tax withheld

1960.18 171.28 1960.18 171.28
b Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld b Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld

65-0786772 65-0786772
a Employee’s social security number 5 Medicare wages and tips 6 Medicare tax withheld a Employee’s social security number 5 Medicare wages and tips 6 Medicare tax withheld

875-67-8803 875-67-8803
c Employer’s name, address and ZIP code c Employer’s name, address and ZIP code
OASIS OUTSOURCING V INC OASIS OUTSOURCING V INC
2054 VISTA PARKWAY STE 300 2054 VISTA PARKWAY STE 300
WEST PALM BEACH FL 33411 WEST PALM BEACH FL 33411

7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9

10 Dependent care benefits 11 Nonqualified plans 12a 10 Dependent care benefits 11 Nonqualified plans 12a
Code

Code

12b 12c 12d 12b 12c 12d
Code

Code
Code

Code
Code

Code

13 Statutory Retirement Third-party 14 Other 13 Statutory Retirement Third-party 14 Other
employee plan sick pay employee plan sick pay

e Employee’s name, address and ZIP code e Employee’s name, address and ZIP code
MARY GRACE TAMAYO MARY GRACE TAMAYO
7 7
2510 NELSON AVE 2510 NELSON AVE
BOYNE FALLS MI 49713 BOYNE FALLS MI 49713

2016 2016
15 State Employer’s state I.D. no. 16 State wages, tips, etc. 15 State Employer’s state I.D. no. 16 State wages, tips, etc.

MI 65-0786772 1960.18 MI 65-0786772 1960.18
Form

W-2
Form

W-2
Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc.

Copy 2 To Be Filed With 59.36 Copy 2 To Be Filed With 59.36
Employee’s State, City, or Employee’s State, City, or
Local Income Tax Return. Local Income Tax Return.

19 Local income tax 20 Locality name 19 Local income tax 20 Locality name

Department of the Treasury – Department of the Treasury –
Internal Revenue Service Internal Revenue Service
Notice to Employee Instructions for Employee Instructions for Employee (Continued) term life insurance over $50,000 (former employees
Do you have to file? Refer to the form 1040 Box 1. Enter this amount on the wages line of your tax (Continued from the back of copy B.) only). See “Other Taxes” in the Form 1040 instructions.
instructions to determine if you are required to file a return. Elective deferrals (codes D, E, F, and S) and P-Excludable moving expense reimbursements paid
tax return. Even if you do not have to file a tax return, Box 2. Enter this amount on the federal income tax designated Roth contributions (codes AA, BB, and EE) directly to employee (not included in boxes 1, 3, or 5)
you may be eligible for a refund if box 2 shows an withheld line of your tax return. under all plans are generally limited to a total of Q-Nontaxable combat pay. See the instructions for
amount or if you are eligible for any credit. Earned Box 5. You may be required to report this amount on $18,000 ($12,500 if you only have SIMPLE plans; Form 1040 or Form 1040A for details on reporting this
income credit (EIC). You may be able to take the $21,000 for section 403(b) plans if you qualify for the amount. R-Employer contributions to your Archer MSA.
Form 8959, Additional Medicare Tax. See Form 1040
15-year rule explained in Pub. 571). Deferrals under Report on form 8853, Archer MSAs and Long-Term
EIC for 2016 if your adjusted gross income (AGI) is instructions to determine if you are required to
code G are limited to $18,000. Deferrals under code H Care Insurance Contracts. S-Employee salary
less than a certain amount. The amount of the credit complete Form 8959.
are limited to $7,000. However, if you were at least age reduction contributions under a section 408(p) SIMPLE
is based on income and family size. Workers without Box 6. This amount includes the 1.45% Medicare Tax
50 in 2016, your employer may have allowed an (not included in box 1) T-Adoption benefits (not
children could qualify for a smaller credit. You and withheld on all Medicare wages and tips shown in box
additional deferral of up to $60500 ($3,000 for section included in box 1). Complete Form 8839, Qualified
any qualifying children must have valid social security 5, as well as the 0.9% Additional Medicare Tax on any Adoption Expenses, to compute any taxable and
numbers (SSNs). You cannot take the EIC if your of those Medicare wages and tips above $200,000. 401(k)(11) and 408(p) SIMPLE plans). This additional
deferral amount is not subject to the overall limit on nontaxable amounts. V-Income from exercise of
investment income is more than the specified amount Box 8. This amount is not included in boxes 1, 3, 5, or nonstatutory stock option(s) (included in boxes 1, 3 (up
for 2016 or if income is earned for services provided 7. For information on how to report tips on your tax elective deferrals. For code G, the limit on elective
deferrals may be higher for the last 3 years before you to social security wage base), and 5). See Pub. 525,
while you were an inmate at a penal institution. For return, see your Form 1040 instructions. You must Taxable and Nontaxable Income, for reporting
2016 income limits and more information, visit file Form 4137, Social Security and Medicare Tax on reach retirement age. Contact your plan administrator
for more information. Amounts in excess of the overall requirements.. W-Employer contributions (including
www.irs.gov/eitc. Also see Pub. 596, Earned Income Unreported Tip Income, with your income tax return to amounts the employee elected to contribute using a
Credit. Any EIC that is more than your tax liability report at least the allocated tip amount unless you can elective deferral limit must be included in income. See
the “Wages, Salaries, Tips, etc.” line instructions for section 125 (cafeteria) plan) to your health savings
is refunded to you, but only if you file a tax return. prove a smaller amount. If you have records that show account. Report on Form 8889, Health Savings
Clergy and religious workers. If you are not subject the actual amount of tips you received, report that Form 1040.
Note: If a year follows code D through H, S, Y, AA, BB, Accounts (HSAs). Y-Deferrals under a section 409A
to social security and Medicare taxes, see Pub. 517, amount even if it is more or less than the allocated nonqualified deferred compensation plan Z-Income
Social Security and Other Information for Members of tips. On Form 4137 you will calculate the social or EE, you made a make-up pension contribution for a
prior year(s) when you were in military service. To under section 409A on a nonqualified deferred
the Clergy and Religious Workers. Corrections. If security and Medicare tax owed on the allocated tips compensation plan. This amount is also included in
your name, SSN, or address is incorrect, correct shown on your Form(s) W-2 that you must report as figure whether you made excess deferrals, consider
these amounts for the year shown, not the current box 1. It is subject to an additional 20% tax plus
Copies B, C, and 2 and ask your employer to correct income and on other tips you did not report to your interest. See “Other Taxes” in the Form 1040
your employment record. Be sure to ask the employer employer. By filing Form 4137, your social security tips year. If no year is shown, the contributions are for the
current year. A-Uncollected social security or RRTA instructions. AA- Designated Roth contributions under
to file Form W-2c, Corrected Wage and Tax will be credited to your social security record (used to a section 401(k) plan. BB- Designated Roth
tax on tips. Include this tax on Form 1040. See “Other
Statement, with the Social Security Administration figure your benefits). contributions under a section 403(b) plan DD-Cost of
Taxes” in the Form 1040 instructions. B-Uncollected
(SSA) to correct any name, SSN, or money amount Box 10. This amount includes the total dependent employer-sponsored health coverage. The amount
Medicare tax on tips. Include this tax on Form 1040.
error reported to the SSA on Form W-2. Be sure to care benefits that your employer paid to you or reported with Code DD is not taxable. EE-
See “Other Taxes” in the Form 1040 instructions. C-
get your copies of Form W-2c from your employer for incurred on your behalf (including amounts from a Designated Roth contributions under a governmental

Last Resume Update February 7, 2017
Address Richmond
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Education

Hermitage high school
High school diploma
Aug 2009 - Jun 2013

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