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MPANY, INC. 6100 RED HOOK QUARTER 0-3 ST. THOMAS U.8.VIRGIN 00802 d Rroolnyaa word ob4rit, motor 58 0 -17- 312 9 * ••••••••••••••• • DAPHNE I WALLACE IVII I••••••••••••••••••••• •••••••••• • mio• •••••••••• •• •• e n • ••••• OM. .M••• •••••••• For OffielalUan Only OHIO No.1602•0000 P.O. BO
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
L : Afeisefra ti4.44 Ft: : .14 i ts& :• . 4.'11•0 15.. re i n .:! 4..ft: ‘,.• • is• c‘i AC "C 1. 4‘s4 4.46. Lk. St' es,i 1 441:: Teta WALLACE a emcee ameacavehe 37894.80 • aide MOS/ wave 42038./4 • Wows nom ord via 42038.74 7 Will mealy dpa 4fini's)"1 • •••••• •I rob. 't.Ivisiont
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aillon aootim Downy wpm 42038./4•• 42038.74 7'1; iii;;;;;;; ;;;;;;;;;;;;;— 6 tTiT6;40.Iii.61rtafit;f and Watt Mitten. ....“-a— DAPHNE L r -- WALLACE : alf<t•41191.1 b• ‘ ?An Le Itle i 4.1 Xit; 'N.'S .L.?: %.. •3.1....•:::?•tt :•51..4 Ai i: • ^ • 7:: .'• i ti•2 .i.r , • .; ,..• • ... • .1. • .
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
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