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Rhode Island, Vermont, WoStillill Illinois, Indiana, Iowa, Kenna, Michigan, Minnesota, Missouri, Nebraska, North Dakota, OWahoma. South Carolina, South Dakota, Tennessee, Wisconsin . Austin, TX 7330 Cinoinnati, OH 4599 Kansas City, MO 6491 For more Information and the Privacy Act and Paperwork Reductio
hvolons S 1297.84 d Employee's social security number 580-29-3823 9 Advance EIC payment , a ErIMOTfiriitAltrrno end Initial Last name Suff. MCDONALD MORRELL PO BOX 306077 ST. THOMAS, VI, 00803 f 5m eels address and tpc o 11 Nonavollad lane 13 re 'Z, " Mr 120 • 14 Other 12c 174 0 4 / / rnrm
Rhode bland, Vermont Woe viTtlia lances, Indiana, Iowa Kamm, .Vii.c.higan, Minnesota, Missouri, Nebraska North Dakota, 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
snotty tar vorrhO 1491.96 bladloare na Wthtgl .93 5" 5`""Tilfra .91 7 Boast snally fps ▪ tir e' • Employee's list name arida** LORETTA LAM an MCDONALD MORRELL I Em Fenn Copy 1-Fer VI ta.feaU of Internal Revatur re Copy 0-For Fmptoync es add nd * contra main 22222 9 Advance em payment a VI Welt:A.)
Island, Vermont, West Virginia Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Wisconsin True ro. PRESIDENT Dote When to file. PIO Form 1098 with Forms 1099, 1098, or 1/Y•243 by February 28, 2005. File Form 1098
6100 RED HOOK QUARTER 8-3 ST. THOMAS U.S.VIRGIN , 00802 d Employee's social smelly number 580-29-3823 e Ernployee's first name end Inklel Limon MCDONALD MORRELL LORF.,TTA rorrn Meth Isbandss wege and Tax Statement Copy El • For Employer 2004 Department of the Tretsthy • Internal Revenue Servl For Priv
Entities connected to both South Dakota and MCDONALD MORRELL

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