W24UCYNI Rev 16

OMB No. 1545-0008 OMB No. 1545-0008

a. Control number 1. Wages, tips, other compensation 2. Federal income tax withheld a. Control number 1. Wages, tips, other compensation 2. Federal income tax withheld
44143 2221.25 100.41 44143 2221.25 100.41
3. Social security wages 4. Social security tax withheld 3. Social security wages 4. Social security tax withheld

5. Medicare wages and tips 6. Medicare tax withheld 5. Medicare wages and tips 6. Medicare tax withheld

c. Employer's name, address, and ZIP code c. Employer's name, address, and ZIP code
CAESARS ENTERPRISE SERVICE LLC CAESARS ENTERPRISE SERVICE LLC
AGENT FOR HARVEY'S TAHOE MGMT CO INC AGENT FOR HARVEY'S TAHOE MGMT CO INC
ONE HARRAH'S COURT ONE HARRAH'S COURT
LAS VEGAS NV 89119 LAS VEGAS NV 89119
7. Social security tips 8. Allocated tips 9. 7. Social security tips 8. Allocated tips 9.

10. Dependent care benefits 11. Nonqualified plans 12a Code See inst. for box 12 10. Dependent care benefits 11. Nonqualified plans 12a Code See inst. for box 12

12b Code 12c Code 12d Code 12b Code 12c Code 12d Code

b. Employer identification number d. Employee's social security number b. Employer identification number d. Employee's social security number
465332354 208-99-4131 465332354 208-99-4131
13. Statutory Retirement Third-party 14. Other 13. Statutory Retirement Third-party 14. Other
Employee plan sick pay Employee plan sick pay

e. Employee's name, address, and ZIP code e. Employee's name, address, and ZIP code
FABIOLA URGILES LUCAS FABIOLA URGILES LUCAS
PO BOX 8 PO BOX 8
STATELINE NV 89449 STATELINE NV 89449

15. State Employer's state ID number 16. State wages, tips, etc. 15. State Employer's state ID number 16. State wages, tips, etc.

2019 2019
17. State income tax 18. Local wages, tips, etc. 17. State income tax 18. Local wages, tips, etc.
Form

W-2 Wage and Tax

Form

W-2 Wage and Tax

Statement Statement
Copy C for
EMPLOYEE'S RECORDS 19. Local income tax 20. Locality name Copy B To Be Filed 19. Local income tax 20. Locality name
(See Notice to Employee on With Employee's
back of Copy B). FEDERAL Tax Return.

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

OMB No. 1545-0008 OMB No. 1545-0008

a. Control number 1. Wages, tips, other compensation 2. Federal income tax withheld a. Control number 1. Wages, tips, other compensation 2. Federal income tax withheld
44143 2221.25 100.41 44143 2221.25 100.41
3. Social security wages 4. Social security tax withheld 3. Social security wages 4. Social security tax withheld

5. Medicare wages and tips 6. Medicare tax withheld 5. Medicare wages and tips 6. Medicare tax withheld

c. Employer's name, address, and ZIP code c. Employer's name, address, and ZIP code
CAESARS ENTERPRISE SERVICE LLC CAESARS ENTERPRISE SERVICE LLC
AGENT FOR HARVEY'S TAHOE MGMT CO INC AGENT FOR HARVEY'S TAHOE MGMT CO INC
ONE HARRAH'S COURT ONE HARRAH'S COURT
LAS VEGAS NV 89119 LAS VEGAS NV 89119
7. Social security tips 8. Allocated tips 9. 7. Social security tips 8. Allocated tips 9.

10. Dependent care benefits 11. Nonqualified plans 12a Code See inst. for box 12 10. Dependent care benefits 11. Nonqualified plans 12a Code See inst. for box 12

12b Code 12c Code 12d Code 12b Code 12c Code 12d Code

b. Employer identification number d. Employee's social security number b. Employer identification number d. Employee's social security number
465332354 208-99-4131 465332354 208-99-4131
13. Statutory Retirement Third-party 14. Other 13. Statutory Retirement Third-party 14. Other
Employee plan sick pay Employee plan sick pay

e. Employee's name, address, and ZIP code e. Employee's name, address, and ZIP code
FABIOLA URGILES LUCAS FABIOLA URGILES LUCAS
PO BOX 8 PO BOX 8
STATELINE NV 89449 STATELINE NV 89449

15. State Employer's state ID number 16. State wages, tips, etc. 15. State Employer's state ID number 16. State wages, tips, etc.

2019 2019
17. State income tax 18. Local wages, tips, etc. 17. State income tax 18. Local wages, tips, etc.
Form

W-2 Wage and Tax

Form

W-2 Wage and Tax

Statement Statement

Copy 2 To Be Filed with 19. Local income tax 20. Locality name Copy 2 To Be Filed with 19. Local income tax 20. Locality name
Employee's State, City, or Employee's State, City, or
Local Income Tax Return. Local Income Tax Return.

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