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Massachusetts Substitute for Form W-2, Wage and Tax Statement
Extracted from PDF file 2023-massachusetts-form-m-4852.pdf, last modified September 2019Substitute for Form W-2, Wage and Tax Statement
Massachusetts Department of Revenue Form M-4852 Substitute for Form W-2, Wage and Tax Statement Complete a separate form for each employer or payer for which a wage or earnings statement is not available. Your information 1 Last name First name Middle initial 2 Social Security no. 3 Street address City/Town State Zip Form W-2 not received I have been unable to obtain (or have received an incorrect) Form W-2, Wage and Tax Statement, from the employer or payer named below. The amounts shown are my best estimates of all wages or payments paid to me and the Massachusetts taxes withheld by this employer or payer. 4 Year 5 Employer or payer’s name Identification number Telephone number Employer or payer’s address City/Town State Zip Include in line 6 the total of wages paid, non-cash payments, tips reported and all other compensation before deductions for taxes, insurance, etc. 6 Wages 7 Massachusetts withholding* 8 Social Security and Medicare tax *To calculate estimated Massachusetts withholding tax, multiply gross income from your federal Form W-2 by 5%. Call 800-829-1040 for copy of your federal Form W-2. Please note that, for a fee, the Social Security Administration may be able to provide you with your state W-2; call them at 800-772-1213 for more information. 9 Explain how you determined the amounts in lines 6 through 8: 10 Describe your efforts to obtain Forms W-2, 1099R or W-2C, Statement of Corrected Income and Tax Amounts, from your employer or payer: 10a Fill in if at any time you were a full-time student 10b Fill in if at any time you requested that your employer or payer not withhold Massachusetts income tax because you reasonably expected to earn less than $8,000 Signature Under penalties of perjury, I declare that I have examined this statement and to the best of my knowledge and belief it is true, correct and complete. Signature For DOR use Wages Date Withholding FICA Approved Rev. 6/19
Form M-4852
More about the Massachusetts Form M-4852 Other TY 2023
We last updated the Substitute for Form W-2, Wage and Tax Statement in February 2024, so this is the latest version of Form M-4852, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form M-4852 directly from TaxFormFinder. You can print other Massachusetts tax forms here.
Other Massachusetts Other Forms:
TaxFormFinder has an additional 126 Massachusetts income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form M-4 | Massachusetts Employee's Withholding Exemption Certificate |
| Form 355SBC | Small Business Corporation Excise Return |
| Form M-3 | Reconciliation of Massachusetts Income Taxes Withheld for Employers |
| Form NHR | New Hire and Independent Contractor Reporting Form |
| Form M-941 | Employer’s Return of Income Taxes Withheld |
View all 127 Massachusetts Income Tax Forms
Form Sources:
Massachusetts usually releases forms for the current tax year between January and April. We last updated Massachusetts Form M-4852 from the Department of Revenue in February 2024.
Historical Past-Year Versions of Massachusetts Form M-4852
We have a total of seven past-year versions of Form M-4852 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2017 Form M-4852
M-4852
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