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Line 1a If you need more space, you may photocopy this schedule or make your own schedules in this format. 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 number. YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART 1301910020 P A - 40 Schedule W - 2S (06 - 13) 2013 Summary of P A - T axable Employee, Non - employee and Miscellaneous Compensation Name shown first on the P A - 40 (if filing jointly) Social Security Number (shown first) T/S A . T/S B . C . Payer name D . E . F . G . H . A. B. C. D. E. Honorarium F . G. H. I. J. K. L. 1301910020 1301910020 PA SCHEDULE W-2S Wage Statement Summary OFFICIAL USE ONLY Use this schedule to list and calculate your total PA-taxable compensation and PA tax withheld from all sources. 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 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 See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required. a copy of your Form W-2 in certain circumstances. Part B Instructions: IMPORTANT: must submit The federal and Pennsylvania (state) wages may be different in Part A and Part B. List each source of income received during the taxable year on a form or statement other than a federal Form W-2. Enter eachpayer’s name. List the does not have separately stated amounts, enter the amount shown in both federal and PA columns. 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 Part A - Federal Forms W-2 SEE THE INSTRUCTIONS FOR WHEN TO SUBMIT FORM(S) W-2 Employer’s identification number from Box b Federal wages from Box 1 Medicare wages from Box 5 PA compensation PA incometax from Box 16 withheld from Box 17 Total Part A - Add the Pennsylvania columns Part B - Miscellaneous and Non-employee Compensation from federal Forms 1099-R,1099-MISC and other statements 1099R code Total federal amount PA tax withheld PA compensation Adjusted plan basis Total Part B - Add the Pennsylvania columns TOTAL- Add the totals from Parts A and B Enter the TOTALS on your PA tax return on: Line 13 Payment type: Executor fee Jury duty pay Covenant not to compete Director’s fee Expert witness fee Damages or settlement for lost wages, other than personal injury Other nonemployee compensation. Describe: Distribution from employer sponsored retirement, pension or qualified deferred compensation plan Distribution from IRA (Traditional or Roth) Distribution from Life Insurance, Annuity or Endowment Contracts Distribution from Charitable Gift Annuities Part A Instructions: You not the income was taxable in PA. 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 CAUTION: must submit and your employer reported your PA wages correctly and withheld the correct amount of PA income tax.You Type ----------------Page (0) Break----------------