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Ntire page. See instructions on the back. Taxpayer s first name and middle initial Taxpayer s last name Your social security number Spouse s first name and middle initial Spouse s last name Spouse s social security number Box c Employer s name and full address ( including ZIP code ) W-2 Record 1 Box 12a Amount Code Box 15 State Box 16 State wages, tips, etc. ( for NYS ) Box 12b Amount Code Box 17 New York State inco.

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