withheld 558.78 7 Sodal security tips 8 Allocated tips o Advance BC payment 10 Dependent care benefits • f Employee's address and ZIP code 11 Norgualified plans 12a See instructions, IC for box 12 I 28.62 13 Se:iilg or /tor n. El n il 21) iI 14 Other 12c 12d A 15 Su* Employer's mate ID