Form 4852, Substitute for Form W-2 or 1099-R Completed Form Examples and Samples
Explore a detailed example of Form 4852, a substitute for a missing W-2. This guide demonstrates filling out the form with estimated wages, federal tax withheld, and essential employee and employer information. Ideal for tax season preparation.
Form 4852 Example – Replacement for Missing W-2
How this form was filled:
This example demonstrates how to complete Form 4852 when a W-2 is missing. It includes estimated wages, federal income tax withheld, and other necessary details. The employee’s details and employer’s information are filled in with estimated amounts, including a signature and date.
Information used to fill out the document:
- Employee Name: John Smith
- Employee Social Security Number: 987-65-4320
- Tax Year: 2024
- Employer's Name: ABC Industries, Inc.
- Employer's Address: 456 Corporate Drive, Business City, USA
- Employer's Identification Number (EIN): 98-7654321
- Estimated Wages: $45,000
- Estimated Federal Income Tax Withheld: $4,500
- Signature: John Smith
- Date: 02/15/2025
What this filled form sample shows:
- Steps to create a substitute for a missing W-2
- Estimated amounts for wages and tax withheld
- Detailed employer information section
- Mandatory signature and date fields completed
Form specifications and details:
| Use Case: | Substitute for a missing or incorrect W-2 |
| Form Number: | 4852 |
| Filing Year: | 2025 |
