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Employer:
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| Employer Identification Number (EIN):205095330 |
| WHY BE NORMAL PIZZA, INC. | |
| 56 MILFORD DRIVE | |
| ROSSVILLE, GA 30741-0000 | |
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Employee:
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| Employee's Social Security Number:
361-56-9005 |
| CHARLES MANTIONE | |
| 1016 CHEVY ST | |
| ALCOA, TN 37701-0000 | |
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| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $119.00 |
| Federal Income Tax Withheld: | $0.00 |
| Social Security Wages: | $33.00 |
| Social Security Tax Withheld: | $7.00 |
| Medicare Wages and Tips: | $119.00 |
| Medicare Tax Withheld: | $1.00 |
| Social Security Tips: | $85.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $0.00 |
| Code "Q" Nontaxable Combat Pay: | $0.00 |
| Code "W" Employer Contributions to a Health Savings Account: | $0.00 |
| Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan: | $0.00 |
| Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan: | $0.00 |
| Code "R" Employer's Contribution to MSA: | $0.00 |
| Code "S" Employer's Contribution to Simple Account: | $0.00 |
| Code "T" Expenses Incurred for Qualified Adoptions: | $0.00 |
| Code "V" Income from exercise of non-statutory stock options: | $0.00 |
| Code "AA" Designated Roth Contributions under a Section 401(k) Plan: | $0.00 |
| Code "BB" Designated Roth Contributions under a Section 403(b) Plan: | $0.00 |
| Code "DD" Cost of Employer-Sponsored Health Coverage: | $0.00 |
| Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan: | $0.00 |
| Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement: | $0.00 |
| Code "GG" Income from Qualified Equity Grants Under Section 83(i): | $0.00 |
| Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year: | $0.00 |
| Third Party Sick Pay Indicator: | Unanswered |
| Retirement Plan Indicator: | Unanswered |
| Statutory Employee: | Not Statutory Employee |
| W2 Submission Type: | Original |
| W2 WHC SSN Validation Code: | Correct SSN |
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Payer:
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| Payer's Federal Identification Number (FIN):340727612 |
| DEFENSE FINANCE AND ACCOUNTING SERVICE | |
| CLEVELAND CENTER | |
| 1240 EAST NINTH STREET | |
| CLEVELAND, OH 44199-2055 | |
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Recipient:
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| Recipient's Identification Number:
361-56-9005 |
| MANTIONE CHARLES | |
| MARYVILLE, TN 37804-4227 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 361569005RET01 |
| Distribution Code Value: | Normal distribution |
| Distribution Code: | 7 |
| Distribution Code Value: | Not significant |
| Distribution Code: | Blank |
| Tax Amount Undetermined Code: | Not checked |
| Total Distribution Code: | Not checked |
| First Year Roth Contribution: | 0000 |
| SEP Indicator: | IRA/SEP/SIMP box not checked |
| FATCA Indicator: | not FATCA |
| Date of Payment for Reportable Death Benefits under Section 6050Y: | 00-00-0000 |
| Tax Withheld: | $659.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $10,402.00 |
| Taxable Amount: | $10,402.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
