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as, Connecticut, Delaware, Kentucky, Maine, Massachusetts, New Hampshire, Nekv Jersey, NewYork, OMo, Per nsylvani Rhode Island, Vermont, West • Cincinnati, OH 45999 Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota. Tennes
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ANY, INC. 6100 RED HOOK QUARTER B-3 ST. THOMAS , 00802 d En 580 loyeelt so 13-4697 Clel security number arnagilettf tarns and Inkiel Last norno CORNELIUS 6501 RED HOOK PLAZA FMB 201 ST. THOMAS, VI, 00802 t E d 2le coda SO. Wain] U.S. Virgin Islands Form Wage and Tax Statement Copy 1-For VI
akota, Oklahoma. South CaroOna, South Dakota, Tennessee, Wisconsin Use the following Internal Revenue Service Center address Austin, 1X 73301 Cincinnati, OH 46999 Kansas Clly, MO 64999 Foe more Information and the Privacy Act and Paperwork Reduction Act Rollos, coo we 2004 Galena Motructions for Co
pla-nr • • - ifto Farm W.CAt lions . I Sit 3812.08 10 V ez 09:rn. 14. 14 Oho-- • •-•••••••• 3269.68 «Rgwil 764. SE Agl JAMIE I CORNELIUS I . : E2149:9/2 *Cr. 52 %Icy P70PM .7 f7 :171T ' etS‘4 17.W .4.4e ' 14 - 1. -.4 %4;.•:1•2 :Ara; • trip "kv ••• .A.Z1 V•40:' •••'. age 44.Z
iveld 647.14 7 Semite nounty Mu t eckd =Os number .. .. . . 9 Actincoo EC peryrrort 100 / A • EmPbYeC0 fret nemo old NW trot runts JAMIE I CORNELIUS 11 Nonqualll•d pkvil 12 Forn W483 helrumbrz p 4717.21 e Soo I, tut .... , - 18.10 r 14 Other 12e i rei i A4 e Cr,, mi &Dem •rvi 7JP cod
agement, LLC 19401 Old Jetton Road Cornelius, NC 28031 Gal Ordinary hi/stands 60 Qualified &viten& C IRS Center vinery partnership filed return Cincinnati, OH 7 Royalties D EiCheck if this is a publicly traded partnership (PT') 8 . sheritawt head gel (loss) Partner 9s, Net long-term capital gain (
FORMA—ION and end n7 Federal Employer ID Number 263172589 Partnership's Name, Address, and Zip Code LEVEL MANAGEMENT LLC 19401 OLD JETTON ROAD CORNELIUS NC 28031 Amount —72 51 0 0 0 0 0 Individuals Filing Form D-400 Enter Amount on: Page 2, lire 35 Page Z Line 36 Page 2, Line 44e Page 2,
nagement, LLC 19401 Old Jetton Road Cornelius, NC 28031 6a Ordinary dividends 6b qualified thydends C FtS Center where partnemrilp filed return Cincinnati, OH 7 Royalties D ['Check if this Is a publicly traded partnorshiP (PiP) 8 Notshottamn cadtal Diadem) ROW Information About the Partner 9* Net l
FORMATION and end n6 Federal Employer ID Number 263172589 Partnership's Name, Address, and Zip Code LEVEL MANAGEMENT LLC 19401 OLD JETTON ROAD CORNELIUS NC 28031 Amount -72 51 0 0 0 0 0 CONFIDENTIAL Individuals Filing Form DADE Enter Amount on: Page 2, Line 35 Page 2, Line 36 Page 2, Lin
st In secured property or who has Kentucky, Maine, Massaohusetts, reason to know that the property has been abandoned. New Hampshire, New Jersey, Cincinnati, OH 45999 New York, Ohio, Pennsylvania, Rhode Island, Vermont, West Virginia Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Neb
rm W4SS. FTE0003 EFTA00233117 22222 }tollare, n n•imhte P NI mpoyeris name, 3CICM119, andLP coda FINANCIAL 1 Em oat and IP code last name CORNELIUS OMB No. 154-0320 1 Wagea epq ollt7COMPOOSIOSI 2 M Income tax withheld 36501.04 5365.00 3 Soots oacedty wages 4 scaled security tax wiltald 39
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