69- Pension plan CHANGES. Please do not staple. Do NOT Cut or Separate Forms on This Page

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1 Cat. No. D Pas o not stap. a Yar/Form orrt Vo OMB No For Oa 9 / W- Us Ony Empoy s nam, arss, an ZIP o Empoy s orrt SSN Prvousy rport Compt an/or ony norrt on t ast orm you. Sow norrt tm r. Form W- ox Was, tps, otr Fra nom tax wt Soa surty was Soa surty tax wt 5 Mar was an tps Mar tax wt Soa surty tps Aoat tps Stat was, tps, t. (a) As prvousy rport Empoyr s nam, arss, an ZIP o Empoyr s Fra EIN Empoyr s stat I.D. numr Empoy s nam (as norrty sown on prvous orm) () Corrt normaton Empoyr s us () Inras (ras) S a o Copy D or nstrutons an t Paprwor Ruton At Not. Copy A For Soa Surty Amnstraton Dpartmnt o t Trasury Form W- (Rv. 0-9) Statmnt o Inom an Tax Amounts Intrna Rvnu Srv Do NOT Cut or Sparat Forms on Ts Pa

2 Yar/Form orrt Vo OMB No / W- Empoy s nam, arss, an ZIP o Empoyr s nam, arss, an ZIP o Empoy s orrt SSN Prvousy rport Compt an/or ony norrt on t ast orm you. Sow norrt tm r. Form W- ox Was, tps, otr Fra nom tax wt Soa surty was Soa surty tax wt 5 Mar was an tps Mar tax wt Soa surty tps Aoat tps (a) As prvousy rport Empoyr s Fra EIN Empoyr s stat I.D. numr Empoy s nam (as norrty sown on prvous orm) () Corrt normaton Empoyr s us () Inras (ras) Stat was, tps, t. Form W- (Rv. 0-9) Copy Statmnt o Inom an Tax Amounts For Stat, Cty, or Loa Tax Dpartmnt Dpartmnt o t Trasury Intrna Rvnu Srv

3 Yar/Form orrt Vo OMB No / W- Empoy s nam, arss, an ZIP o Empoyr s nam, arss, an ZIP o Empoy s orrt SSN Prvousy rport Compt an/or ony norrt on t ast orm you. Sow norrt tm r. Form W- ox Was, tps, otr Fra nom tax wt Soa surty was Soa surty tax wt 5 Mar was an tps Mar tax wt Soa surty tps Aoat tps (a) As prvousy rport Empoyr s Fra EIN Empoyr s stat I.D. numr Empoy s nam (as norrty sown on prvous orm) () Corrt normaton Empoyr s us () Inras (ras) Stat was, tps, t. Form W- (Rv. 0-9) Copy B Statmnt o Inom an Tax Amounts To B F Wt Empoy s FEDERAL Tax Rturn Dpartmnt o t Trasury Intrna Rvnu Srv

4 Yar/Form orrt Vo OMB No / W- Empoy s nam, arss, an ZIP o Empoyr s nam, arss, an ZIP o Empoy s orrt SSN Prvousy rport Compt an/or ony norrt on t ast orm you. Sow norrt tm r. Form W- ox Was, tps, otr Fra nom tax wt Soa surty was Soa surty tax wt 5 Mar was an tps Mar tax wt Soa surty tps Aoat tps (a) As prvousy rport Empoyr s Fra EIN Empoyr s stat I.D. numr Empoy s nam (as norrty sown on prvous orm) () Corrt normaton Empoyr s us () Inras (ras) Stat was, tps, t. Form W- (Rv. 0-9) Statmnt o Inom an Tax Amounts Copy C For Empoy s Rors Dpartmnt o t Trasury Intrna Rvnu Srv

5 Ts s a orrt Form W-, Wa an Tax Statmnt, or t tax yar sown n ox a. I you av an nom tax rturn or t yar sown, you may av to an amn rturn. Compar amounts on ts orm wt tos rport on your nom tax rturn. I t orrt amounts an your nom tax aty, Form 00X, Amn U.S. Invua Inom Tax Rturn, wt opy B o ts Form W- to amn t rturn you aray. I you av not your rturn or t yar sown n ox a, atta opy B o t orna Not to Empoy Form W- you rv rom your mpoyr an opy B o ts Form W- to your rturn wn you t. I oxs or av any oxs mar, ox w sow t orna normaton an ox w sow t orrt normaton. For mor normaton, ontat your narst Intrna Rvnu Srv o. Empoys n Amran Samoa, Guam, Commonwat o t Nortrn Marana Isans, or t U.S. Vrn Isans sou ontat tr oa taxn autorty or mor normaton.

6 Yar/Form orrt Vo OMB No / W- Empoy s nam, arss, an ZIP o Empoyr s nam, arss, an ZIP o Empoy s orrt SSN Prvousy rport Compt an/or ony norrt on t ast orm you. Sow norrt tm r. Form W- ox Was, tps, otr Fra nom tax wt Soa surty was Soa surty tax wt 5 Mar was an tps Mar tax wt Soa surty tps Aoat tps (a) As prvousy rport Empoyr s Fra EIN Empoyr s stat I.D. numr Empoy s nam (as norrty sown on prvous orm) () Corrt normaton Empoyr s us () Inras (ras) Stat was, tps, t. Form W- (Rv. 0-9) Copy Statmnt o Inom an Tax Amounts To B F Wt Empoy s Stat, Cty, or Loa Inom Tax Rturn Dpartmnt o t Trasury Intrna Rvnu Srv

7 Yar/Form orrt Vo OMB No / W- Empoy s nam, arss, an ZIP o Empoyr s nam, arss, an ZIP o Empoy s orrt SSN Prvousy rport Compt an/or ony norrt on t ast orm you. Sow norrt tm r. Form W- ox Was, tps, otr Fra nom tax wt Soa surty was Soa surty tax wt 5 Mar was an tps Mar tax wt Soa surty tps Aoat tps (a) As prvousy rport Empoyr s Fra EIN Empoyr s stat I.D. numr Empoy s nam (as norrty sown on prvous orm) () Corrt normaton Empoyr s us () Inras (ras) Stat was, tps, t. Form W- (Rv. 0-9) Statmnt o Inom an Tax Amounts Copy D For Empoyr Dpartmnt o t Trasury Intrna Rvnu Srv

8 Instrutons Paprwor Ruton At Not. W as or t normaton on ts orm to arry out t Intrna Rvnu aws o t Unt Stats. You ar rqur to v us t normaton. W n t to nsur tat you ar ompyn wt ts aws an to aow us to ur an ot t rt amount o tax. T tm n to ompt an ts orm w vary pnn on nvua rumstans. T stmat avra tm s 5 mnuts. I you av ommnts onrnn t auray o ts tm stmat or sustons or man ts orm smpr, w wou appy to ar rom you. You an wrt to t Intrna Rvnu Srv, Attnton: Tax Forms Commtt, PC:FP, Wasnton, DC 0. DO NOT sn ts orm to ts arss. Insta, s Wr To F ow. Itms To Not Sn Fn Arss. Sn a Forms W- an W-, Transmtta o Inom an Tax Statmnts, to t Soa Surty Amnstraton s Ws-Barr Data Opratons Cntr. S Wr To F ow or t arss. Dat o Form W-. Box, Empoyr s us, an us to ntr t at ts orm s prpar. Purpos o Form. Us Form W- to orrt rrors on Forms W-, W-AS, W-CM, W-GU, or W-VI wt t Soa Surty Amnstraton (SSA). Us a sparat Form W- or a typ o orm sown n ox a o Form W-. Do not us Form W- to aoat apay was unr statut. Contat any SSA o or nstrutons. How To F. Us a Form W- to sn Forms W- to t SSA unss you ar ony orrtn t mpoys nams, arsss, or soa surty numrs (SSNs). I ts ar your ony orrtons, sn ust Form W-. Avs your mpoys to orrt tr SSN an/or nam on tr orna Form W-. To upat your arss o ror, s t ast pararap unr ox. Wr To F. Sn t ntr rst pa o Copy A o Form W- wt t ntr rst pa o Form W- ( appa) to t SSA. Sn to t Soa Surty Amnstraton, Data Opratons Cntr, Ws-Barr, PA 9. Dstrut t rmann ops o Form W- as not on t ottom o a orm. Gnra Instrutons Form W- s a sx-part orm. Pas ma sur a ops ar. I any tm sows a oar an, an on o t amounts s zro, ntr -0-. Do not av an. Sow natv amounts (rass) n oumn () n parntss. Corrtn Mor Tan On Form W- or an Empoy. Tr ar two ways to prpar a orrton or an mpoy wo ot mor tan on Form W- unr t sam mpoyr ntaton numr (EIN) or t tax yar. You an onsr a t Forms W- wn trmnn t amounts to ntr on Form W-, as sown n t xamp ow, or you an a sn Form W- to orrt on o t mutp Forms W- ssu. Howvr, stat, oa, an Fra ovrnmnt mpoyrs wo ar prparn orrtons or mpoys sut to Mar Qua Govrnmnt Empoymnt (MQGE) must oow t nstrutons n t Not or Boxs 5 an. Examp: Mary Smt rv two Forms W- or tax yar 99 unr t sam EIN. On orm norrty rport soa surty was o $0,000 an t son rport soa surty was o $0,000. A Form W- to an $0,000 to $5,000 sou sow $50,000 n oumn (a), $5,000 n oumn (), an a $5,000 ras n oumn (). An Rsn Status Can. I your mpoy ot a nw soa surty ar aus o a an to s or r an rsn status, an tat ar sows a rnt nam or SSN tan you sow on a Form W-, Form W- to orrt t nam an/or numr. Us on Form W- or a pror yar orrt. Avs t mpoy to ontat s or r oa SSA o monts atr you Form W- to sur s or r rors ar upat. Mtary Rsrv Pay. I you ar orrtn mtary rsrv pay, us sparat Forms W- an W- an not on t Forms W- wat wa amounts ar or atv uty or atv uty or trann. Do not omn ts paymnts wt ruar soa surty wa paymnts. Mutp Forms. I a sn Form W- os not prov nou an spas or orrtons, us atona Forms W-. Unvra Forms W-. Kp or yars any mpoy (rpnt) ops o Forms W- you tr to vr ut ou not. Sp Instrutons Box a Yar/Form orrt. Entr t yar an typ o orm orrt. For t typ, ntr, AS, CM, GU, or VI. For xamp, 9/ wou sow tat t Form W- was orrtn a 99 Form W-. Vo. I you ma an rror, mar ts ox to vo t orm. Box Empoy s nam, arss, an ZIP o. Inu n t arss t numr, strt, apt. or sut no., or P.O. Box numr ma s not vr to a strt arss. I an arss s outs t Unt Stats or ts possssons or trrtors, nsta o provn ty, town, post o, stat, an ZIP o, v t oown normaton: ty, provn or stat, posta o, an t nam o t ountry. Do not arvat t ountry nam. I you ar orrtn t nam or arss, mar t ox. Box Empoyr s nam, arss, an ZIP o. Ts sou t sam as sown on your Forms 9, 9, or 9. I you ar orrtn your nam or arss, mar t ox. T IRS w not us Form W- to upat your arss o ror. I you ws to an your arss, Form, Can o Arss. To t Form, or any otr IRS orm, a -00-TAX-FORM (-00-9-). Box. Ony Stat an oa ovrnmnt mpoyrs wo av a spa armnt wt t SSA an us ts ox. Contat your Stat Soa Surty Amnstrator or man pr-9 tax yar orrtons. Box Empoyr s Fra EIN. Sow t orrt numr assn to you y t IRS ( ). Box Empoyr s stat I.D. numr. You o not n to ompt ts ox. Ts numr s assn y t nvua stats an you may want to ompt t ox you us ops o ts orm or your stat rturns. Boxs an. Mar t oxs n ox as ty wr on t orna Form W-; n ox, mar tm as ty sou av n. In ox, av an any ox mar n rror on t orna. For xamp: you mar t pnson ox on t orna Form W- y msta. Mar t pnson ox n ox ut o not mar t pnson ox n ox. Box Empoyr s us. Ts s an optona ox you may us to nty nvua orms or ntr t at t orm s prpar. Boxs an. Compt ts oxs ony you ws to orrt an mpoy s SSN or nam. Boxs,,, 0, an. For t tms you ar ann, ntr n oumn (a) t amount rport on t orna Form W-. Entr n oumn () t orrt amount. Entr n oumn () t rn twn oumns (a) an (). Sow any ras n parntss. Do not put an ntry n any o t oxs unss you ar man a an. For t xpton, s Not ow. Box Fra nom tax wt. Us ts ox ony wn man orrtons aus o amnstratv rrors. Boxs 5 an. Compt ts oxs to orrt Mar was an tps an Mar tax wt or 99 an atr yars. Empoyrs sou aso us ts oxs to orrt MQGE was or any yar. Not: A stat, oa, or Fra ovrnmnt mpoyr orrtn ony soa surty was an/or soa surty tps (oxs an/or ), or a Mar MQGE mpoy, or 99 an atr yars, must aso ompt Mar was an tps on n 5, oumns (a), (), an (). Entr t tota Mar was an tps, nun MQGE-ony was, vn tr s no an to t tota Mar was an tps prvousy rport. Ban oxs Us ts oxs to ntr orrtons to tms on Form W- not sown sparaty on ts orm. Entr t ox numr, ox nam, an o ( appa) rom Form W-. Boxs an tms orrt r ar avan EIC paymnt, pnnt ar nts, nonqua s, nts nu n ox, unot soa surty an/or Mar taxs on tps, ost o roup-trm nsuran ovra ovr $50,000, tv rras (os D H, ox ), s pay not nu as nom, mpoy usnss xpnss, an otr tms you rport on your mpoy s orna Form W-. B sur to a t tms. Boxs,, 0, an. I your ONLY ans to t orna Form W- ar to stat or oa ata, DO NOT sn Copy A o Form W- to t SSA. Prnt on ry papr

W-2. Wage and Tax Statement 1 Copy A For Social Security Administration. Do NOT Cut or Separate Forms on This Page. Void.

W-2. Wage and Tax Statement 1 Copy A For Social Security Administration. Do NOT Cut or Separate Forms on This Page. Void. Attntion! This form is provi for informational purposs an shoul not rprou on prsonal omputr printrs y iniviual taxpayrs for filing. Th print vrsion of this form is a "mahin raal" form. As suh, it must