2016 W-2 and EARNINGS SUMMARY

Employee Reference Copy This blue Earnings Summary section is included with your W-2 to help describe portions in more detail.
Wage and Tax
W-2 Statement
Copy C for employee’s records.
2016
OMB No. 1545-0008
The reverse side includes general information that you may also find helpful.
1. The following information reflects your final 2016 pay stub plus any adjustments submitted by your employer.
d Control number Dept. Corp. Employer use only Gross Pay Social Security GA. State Income Tax
88336.62 5171.85 4420.20
077406 CHIC/B6S 006400 A 2992 Tax Withheld Box 17 of W-2
c Employer’s name, address, and ZIP code Box 4 of W-2 SUI/SDI
AMDOCS INC Box 14 of W-2
Fed. Income 19541.31 Medicare Tax 1209.55
1390 TIMBERLAKE MANOR Tax Withheld Withheld
CHESTERFIELD MO 63017 Box 2 of W-2 Box 6 of W-2

2. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
Batch #02053
Wages, Tips, other Social Security Medicare GA. State Wages,
e/f Employee’s name, address, and ZIP code Compensation Wages Wages Tips, Etc.
Box 1 of W-2 Box 3 of W-2 Box 5 of W-2 Box 16 of W-2
SHIVANGI D GARDE
13300 MORRIS RD Gross Pay 88,336.62 88,336.62 88,336.62 88,336.62
UNIT 65 Plus GTL (C-Box 12) 80.34 80.34 80.34 80.34
ALPHARETTA GA 30004 Less DependentFSA/DCB 5,000.00 5,000.00 5,000.00 5,000.00
b Employer’s FED ID number a Employee’s SSA number
Reported W-2 Wages 83,416.96 83,416.96 83,416.96 83,416.96
43-1339487 874-54-0269
1 Wages, tips, other comp. 2 Federal income tax withheld
83416.96 19541.31
3 Social security wages 4 Social security tax withheld
83416.96 5171.85
5 Medicare wages and tips 6 Medicare tax withheld
83416.96 1209.55
7 Social security tips 8 Allocated tips

Verification Code 10 Dependent care benefits 3. Employee W-4 Profile. To change your Employee W-4 Profile Information, file a new W-4 with your payroll dept.
97A5-5E2F-4196-8739 5000.00
11 Nonqualified plans 12a See instructions for box 12

12b
C 80.34 SHIVANGI D GARDE Social Security Number:874-54-0269
14 Other 13300 MORRIS RD Taxable Marital Status: MARRIED
12c
12d UNIT 65 Exemptions/Allowances:
____________________
13 Stat emp. Ret. plan 3rd party sick pay ALPHARETTA GA 30004 FEDERAL: 0 $367 Additional Tax
STATE: 1 Plus 1 Dependents
15 State Employer’s state ID no. 16 State wages, tips, etc.
GA 2000963-BF 83416.96
17 State income tax 18 Local wages, tips, etc.
4420.20
19 Local income tax 20 Locality name ¤ 2016 ADP, LLC

1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld
83416.96 19541.31 83416.96 19541.31 83416.96 19541.31
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
83416.96 5171.85 83416.96 5171.85 83416.96 5171.85
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
83416.96 1209.55 83416.96 1209.55 83416.96 1209.55
d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only
077406 CHIC/B6S 006400 A 2992 077406 CHIC/B6S 006400 A 2992 077406 CHIC/B6S 006400 A 2992
c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code
AMDOCS INC AMDOCS INC AMDOCS INC
1390 TIMBERLAKE MANOR 1390 TIMBERLAKE MANOR 1390 TIMBERLAKE MANOR
CHESTERFIELD MO 63017 CHESTERFIELD MO 63017 CHESTERFIELD MO 63017

b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number
43-1339487 874-54-0269 43-1339487 874-54-0269 43-1339487 874-54-0269
7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips

Verification Code 10 Dependent care benefits 9 10 Dependent care benefits 9 10 Dependent care benefits
97A5-5E2F-4196-8739 5000.00 5000.00 5000.00
11 Nonqualified plans 12a See instructions for box 12 11 Nonqualified plans 12a
12 11 Nonqualified plans 12a
C 80.34 C 80.34 C 80.34
14 Other 12b 14 Other 12b 14 Other 12b
12c 12c 12c
12d 12d 12d
13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay

e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code
SHIVANGI D GARDE SHIVANGI D GARDE SHIVANGI D GARDE
13300 MORRIS RD 13300 MORRIS RD 13300 MORRIS RD
UNIT 65 UNIT 65 UNIT 65
ALPHARETTA GA 30004 ALPHARETTA GA 30004 ALPHARETTA GA 30004
15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc.
GA 2000963-BF 83416.96 GA 2000963-BF 83416.96 GA 2000963-BF 83416.96
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
4420.20 4420.20 4420.20
19 Local income tax 20 Locality name 19 Local income tax 20 Locality name 19 Local income tax 20 Locality name

Federal Filing Copy GA.State Reference Copy GA.State Filing Copy

Wage and Tax Wage and Tax Wage and Tax
W-2 Statement
Copy B to be filed with employee’s
OMB
2016 No. 1545-0008
Federal Income Tax Return.
W-2 Statement 2016
OMB No. 1545-0008
Copy 2 to be filed with employee’s State Income Tax Return.
W-2 Statement OMB
2016
Copy 2 to be filed with employee’s State Income Tax Return.
No. 1545-0008
Instructions for Employee Box 12. The following list explains the codes shown in box 12. You P—Excludable moving expense reimbursements paid directly to
may need this information to complete your tax return. Elective employee (not included in boxes 1, 3, or 5)
Box 1. Enter this amount on the wages line of your tax return. deferrals (codes D, E, F, and S) and designated Roth contributions Q—Nontaxable combat pay. See the instructions for Form 1040 or
Box 2. Enter this amount on the federal income tax withheld line of (codes AA, BB, and EE) under all plans are generally limited to a total Form 1040A for details on reporting this amount.
your tax return. of $18,000 ($12,500 if you only have SIMPLE plans; $21,000 R—Employer contributions to your Archer MSA. Report on Form 8853,
Box 5. You may be required to report this amount on Form 8959, for section 403(b) plans if you qualify for the 15-year rule explained in Archer MSAs and Long-Term Care Insurance Contracts.
Additional Medicare Tax. See the Form 1040 instructions to Pub. 571). Deferrals under code G are limited to $18,000. Deferrals
under code H are limited to $7,000. S—Employee salary reduction contributions under a section 408(p)
determine if you are required to complete Form 8959. SIMPLE plan (not included in box 1)
Box 6. This amount includes the 1.45% Medicare Tax withheld on However, if you were at least age 50 in 2016, your employer may
have allowed an additional deferral of up to $6,000 ($3,000 for section T—Adoption benefits (not included in box 1). Complete Form 8839,
all Medicare wages and tips shown in box 5, as well as the 0.9% 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is Qualified Adoption Expenses, to compute any taxable and nontaxable
Additional Medicare Tax on any of those Medicare wages and tips not subject to the overall limit on elective deferrals. For code G, the amounts.
above $200,000. limit on elective deferrals may be higher for the last 3 years before you V—Income from exercise of nonstatutory stock option(s) (included in
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For reach retirement age. Contact your plan administrator for more boxes 1, 3 (up to social security wage base), and 5). See Pub. 525,
information on how to report tips on your tax return, see your Form information. Amounts in excess of the overall elective deferral limit Taxable and Nontaxable Income, for reporting requirements.
1040 instructions. must be included in income. See the “Wages, Salaries, Tips, etc.” line W—Employer contributions (including amounts the employee elected
You must file Form 4137, Social Security and Medicare Tax on instructions for Form 1040. to contribute using a section 125 (cafeteria) plan) to your health
Unreported Tip Income, with your income tax return to report at Note: If a year follows code D through H, S, Y, AA, BB, or EE, you savings account. Report on Form 8889, Health Savings Accounts
least the allocated tip amount unless you can prove that you made a make-up pension contribution for a prior year(s) when you (HSAs).
received a smaller amount. If you have records that show the actual were in military service. To figure whether you made excess deferrals, Y—Deferrals under a section 409A nonqualified deferred compensation
amount of tips you received, report that amount even if it is more or consider these amounts for the year shown, not the current year. If no plan
less than the allocated tips. On Form 4137 you will calculate the year is shown, the contributions are for the current year. Z—Income under a nonqualified deferred compensation plan that fails
social security and Medicare tax owed on the allocated tips shown A—Uncollected social security or RRTA tax on tips. Include this tax on to satisfy section 409A. This amount is also included in box 1. It is
on your Form(s) W-2 that you must report as income and on other Form 1040. See “Other Taxes” in the Form 1040 instructions. subject to an additional 20% tax plus interest. See “Other Taxes” in the
tips you did not report to your employer. By filing Form 4137, your B—Uncollected Medicare tax on tips. Include this tax on Form 1040. Form 1040 instructions.
social security tips will be credited to your social security record See “Other Taxes” in the Form 1040 instructions. AA—Designated Roth contributions under a section 401(k) plan
(used to figure your benefits). C—Taxable cost of group-term life insurance over $50,000 (included in BB—Designated Roth contributions under a section 403(b) plan
Verification Code. If this field is populated, enter this code when it boxes 1, 3 (up to social security wage base), and 5) DD—Cost of employer-sponsored health coverage. The amount
is requested by your tax return preparation software. It is possible D—Elective deferrals to a section 401(k) cash or deferred arrangement. reported with Code DD is not taxable.
your software or preparer will not request the code. The code is not Also includes deferrals under a SIMPLE retirement account that is part EE—Designated Roth contributions under a governmental section
entered on paper-filed returns. of a section 401(k) arrangement. 457(b) plan. This amount does not apply to contributions under a tax-
Box 10. This amount includes the total dependent care benefits that E—Elective deferrals under a section 403(b) salary reduction exempt organization section 457(b) plan.
your employer paid to you or incurred on your behalf (including agreement Box 13. If the “Retirement plan” box is checked, special limits may
amounts from a section 125 (cafeteria) plan). Any amount over F—Elective deferrals under a section 408(k)(6) salary reduction SEP apply to the amount of traditional IRA contributions you may deduct.
$5,000 is also included in box 1. Complete Form 2441, Child and G—Elective deferrals and employer contributions (including nonelective See Pub. 590-A, Contributions to Individual Retirement Arrangements
Dependent Care Expenses, to compute any taxable and nontaxable deferrals) to a section 457(b) deferred compensation plan (IRAs).
amounts. H—Elective deferrals to a section 501(c)(18)(D) tax-exempt Box 14. Employers may use this box to report information such as
Box 11. This amount is (a) reported in box 1 if it is a distribution organization plan. See “Adjusted Gross Income” in the Form 1040 state disability insurance taxes withheld, union dues, uniform
made to you from a nonqualified deferred compensation or instructions for how to deduct. payments, health insurance premiums deducted, nontaxable income,
nongovernmental section 457(b) plan or (b) included in box 3 J—Nontaxable sick pay (information only, not included in boxes 1, 3, educational assistance payments, or a member of the clergy's
and/or 5 if it is a prior year deferral under a nonqualified or or 5) parsonage allowance and utilities. Railroad employers use this box to
section 457(b) plan that became taxable for social security and report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax,
K—20% excise tax on excess golden parachute payments. See “Other Medicare tax and Additional Medicare Tax. Include tips reported by the
Medicare taxes this year because there is no longer a substantial Taxes” in the Form 1040 instructions.
risk of forfeiture of your right to the deferred amount. This box employee to the employer in railroad retirement (RRTA) compensation.
L—Substantiated employee business expense reimbursements Note: Keep Copy C of Form W-2 for at least 3 years after the due date
should not be used if you had a deferral and a distribution in the (nontaxable)
same calendar year. If you made a deferral and received a for filing your income tax return. However, to help protect your social
distribution in the same calendar year, and you are or will be age M—Uncollected social security or RRTA tax on taxable cost of security benefits, keep Copy C until you begin receiving social
62 by the end of the calendar year, your employer should file group-term life insurance over $50,000 (former employees only). See security benefits, just in case there is a question about your work
Form SSA-131, Employer Report of Special Wage Payments, with “Other Taxes” in the Form 1040 instructions. record and/or earnings in a particular year.
the Social Security Administration and give you a copy. N—Uncollected Medicare tax on taxable cost of group-term life
insurance over $50,000 (former employees only). See “Other Taxes” in Department of the Treasury - Internal Revenue Service
the Form 1040 instructions.

NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS.

This information is being furnished to the Internal

Revenue Service. If you are required to file a tax Notice to Employee
return, a negligence penalty or other sanction may
be imposed on you if this income is taxable and Do you have to file? Refer to the Form 1040 instructions
you fail to report it. to correct any name, SSN, or money amount error
to determine if you are required to file a tax return. Even if reported to the SSA on Form W-2. Be sure to get your
IMPORTANT NOTE: you do not have to file a tax return, you may be eligible for copies of Form W-2c from your employer for all
In order to insure efficient processing,
a refund if box 2 shows an amount or if you are eligible for corrections made so you may file them with your tax
attach this W-2 to your tax return like this
any credit. return. If your name and SSN are correct but are not the
(following agency instructions): Earned income credit (EIC). You may be able to take the same as shown on your social security card, you should
EIC for 2016 if your adjusted gross income (AGI) is less ask for a new card that displays your correct name at any
than a certain amount. The amount of the credit is based SSA office or by calling 1-800-772-1213. You also may
on income and family size. Workers without children could visit the SSA at www.socialsecurity.gov.
qualify for a smaller credit. You and any qualifying children Cost of employer-sponsored health coverage (if such
must have valid social security numbers (SSNs). You cost is provided by the employer). The reporting in box
cannot take the EIC if your investment income is more than 12, using code DD, of the cost of employer-sponsored
TAX RETURN the specified amount for 2016 or if income is earned for health coverage is for your information only. The amount
services provided while you were an inmate at a penal reported with code DD is not taxable.
institution. For 2016 income limits and more information, Credit for excess taxes. If you had more than one
visit www.irs.gov/eitc. Also see Pub. 596, Earned Income employer in 2016 and more than $7,347 in social security
THIS Credit. Any EIC that is more than your tax liability is and/or Tier 1 railroad retirement (RRTA) taxes were
OTHER refunded to you, but only if you file a tax return.
FORM withheld, you may be able to claim a credit for the excess
W-2’S
W-2 Clergy and religious workers. If you are not subject to against your federal income tax. If you had more than one
social security and Medicare taxes, see Pub. 517, Social railroad employer and more than $4,321.80 in Tier 2
Security and Other Information for Members of the Clergy RRTA tax was withheld, you also may be able to claim a
and Religious Workers. credit. See your Form 1040 or Form 1040A instructions
Corrections. If your name, SSN, or address is incorrect, and Pub. 505, Tax Withholding and Estimated Tax.
correct Copies B, C, and 2 and ask your employer to
correct your employment record. Be sure to ask the
employer to file Form W-2c, Corrected Wage and Tax
Statement, with the Social Security Administration (SSA)

Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service