Form 499r-2c/w-2cpr - Corrected Withholding Statement - 2013

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Corrección
Formulario
499R-2
/W-2
PR
ESTADO LIBRE ASOCIADO DE PUERTO RICO - COMMONWEALTH OF PUERTO RICO
C
C
Correction
Departamento de Hacienda - Department of the Treasury
Form
Duplicado
Rev. 08.13
CORRECCION AL COMPROBANTE DE RETENCION
Duplicate
No envíe a la Adm. Seg. Soc.
CORRECTED WITHHOLDING STATEMENT
Do not send to Soc. Sec. Adm.
1.
FECHA CESE DE OPERACIONES
AÑO A CORREGIRSE
2a.
NUM. SEGURO SOCIAL EMPLEADO
2b.
NUM. DE IDENTIFICACION PATRONAL
Year Being Corrected
Cease of Operations Date
Employer Identification No. (EIN)
Employee's Social Security No.
2013
Día - Day _______ Mes - Month _______ Año - Year _______
3a.
NOMBRE - First Name
APELLIDO(S) - Surname(s)
4a.
NOMBRE Y DIRECCION POSTAL DEL PATRONO
Employer's Name and Mailing Address
3b.
DIRECCION POSTAL DEL EMPLEADO - Employee's Mailing Address
4b. NUMERO DE TELEFONO - Telephone Number
COMPLETE LINEA 5a o 5b SOLAMENTE SI LA INFORMACION ORIGINAL ESTABA INCORRECTA. ANOTE NUMERO Y NOMBRE INCORRECTOS. Complete line 5a or 5b only if the original
information reported was incorrect. Enter the incorrect Social Security number and name.
5b.
NOMBRE DEL EMPLEADO (INCORRECTO) - Employee's Incorrect Name
5a. NUM. SEGURO SOCIAL (INCORRECTO)
5c. Fecha en que comenzó a recibir la pensión:
Incorrect Social Security No.
Date on which you started to receive the pension:
Nombre - First Name
Apellido(s) - Surname(s)
Día - Day _______ Mes - Month _______ Año - Year _______
Línea - Line
a) Según se Informó Originalmente
b) Información Correcta
c) Aumento (Reducción) (Diferencia entre a y b)
Increase (Decrease) (Difference between a and b)
As Originally Reported
Correct Information
6.
COSTO DE PENSION O ANUALIDAD
Cost of Pension or Annuity
6A.
COSTO DE CUBIERTA DE SALUD AUSPICIADA POR EL PATRONO
Cost of Employer - Sponsored Health Coverage
6B.
DONATIVOS
Charitable Contributions
7.
SUELDOS
Wages
8.
COMISIONES
Commissions
9.
CONCESIONES
Allowances
PROPINAS
10.
Tips
11.
TOTAL = 7 + 8 + 9 + 10
12.
GASTOS REEMBOLSADOS Y BENEFICIOS MARGINALES
Reimbursed Expenses and Fringe Benefits
13.
CONTRIBUCION RETENIDA
Tax Withheld
14.
FONDO DE RETIRO GUBERNAMENTAL
Governmental Retirement Fund
15.
APORTACIONES A PLANES CUALIFICADOS
Contributions to CODA PLANS
16.
SALARIOS BAJO LEY 324-2004
Salaries under Act 324-2004
16A.
APORTACIONES AL PROGRAMA AHORRA Y DUPLICA TU DINERO
Contributions to the Save and Double your Money Program
17.
TOTAL SUELDOS SEGURO SOCIAL
Social Security Wages
18.
SEGURO SOCIAL RETENIDO
Social Security Tax Withheld
19.
TOTAL SUELDOS Y PROPINAS MEDICARE
Medicare Wages and Tips
20.
CONTRIBUCION MEDICARE RETENIDA
Medicare Tax Withheld
21.
PROPINAS SEGURO SOCIAL
Social Security Tips
22.
SEGURO SOCIAL NO RETENIDO EN PROPINAS
Uncollected Social Security Tax on Tips
23.
CONTRIBUCION MEDICARE NO RETENIDA EN PROPINAS
Uncollected Medicare Tax on Tips
RAZONES PARA EL CAMBIO:
Reasons for the change:
TITULO - Title
FECHA - Date
FIRMA DEL PATRONO O SU REPRESENTANTE AUTORIZADO
Employer's or Duly Authorized Agent's Signature
NUM. CONFIRMACION DE RADICACION ELECTRONICA
NUM. CONTROL - Control No.
NUM. CONTROL DEL COMPROBANTE ORIGINAL
Electronic Filing Confirmation No.
Control No. of original withholding statement
Original - Administración de Seguro Social
ANTES DE COMPLETAR ESTE FORMULARIO, VEANSE INSTRUCCIONES AL DORSO DE COPIA D
Original - Social Security Administration
BEFORE FILING THIS FORM, SEE INSTRUCTIONS ON BACK OF COPY D

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