Pa Form W2S – Fill Out and Use

1201910021

PA SCHEDULE W-2S

Wage Statement Summary

Summary of PA-Taxable Employee, Non-employee and Miscellaneous Compensation

Use this schedule to list and calculate your total PA-taxable compensation and PA tax withheld from all sources.

Part A Instructions: List each federal Form W-2 for you and your spouse, if married, received from your employer(s). In the first column enter T for the taxpayer’s Social Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Forms W-2, enter each employer’s federal identification num- ber. Enter the amounts from the Forms W-2 in each column. IMPORTANT: You do not have to submit a copy of your Form W-2 if you earned all your income in Pennsylvania and your employer reported your PA wages correctly and withheld the correct amount of PA income tax. You must submit a copy of your Form W-2 in cer- tain circumstances. See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required.

Part B Instructions: List each source of income received during the taxable year on a form or statement other than a federal Form W-2. Enter each payer’s name. List the payment type that most closely describes the source of your non-employee compensation. Enter the amount of other compensation that you earned. If the form or statement does not have separately stated amounts, enter the amount shown in both federal and PA columns.

IMPORTANT: You must submit a copy of each form and statement that you list in Part B, whether or not the payer withheld any PA income tax and regardless of

whether or not the income was taxable in PA. CAUTION: The federal and Pennsylvania (state) wages may be different in Part A and Part B.

If you need more space, you may photocopy this schedule or make your own schedules in this format.

Part A - Federal Forms W-2 SEE THE INSTRUCTIONS FOR WHEN TO SUBMIT FORM(S) W-2

Total Part A- Add the Pennsylvania columns

Part B - Miscellaneous and Non-employee Compensation from federal Forms 1099-R, 1099-MISCand other statements

YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART

Total Part B - Add the Pennsylvania columns

TOTAL - Add the totals from Parts A and B

H. Other nonemployee compensation. Describe:

I. Distribution from employer sponsored retirement, pension or qualified deferred compensation plan

J. Distribution from IRA(Traditional or Roth) K.Distribution from Life Insurance,Annuity or Endowment Contracts

L. Distribution from Charitable GiftAnnuities