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92 hiergoora tirleml les 92 9 Advance EIO paymoro. 11 Nonouelified plane 13 M ay re ;W ir t MY n 14 Other 2 VI Income tax withheld 3837.00 4 Sochi' moudly lax wlthhald 2444.47 5 Medicare tax Thad ■ 71.69 ib 8.o riV4SSi ligructio‘D 12o 12d 3 15.82 U.S. Virgin Islands Wage and Tax Statem
ducts to a buyer (redolent) tor rube P. 13 Excess gcklen parachute payments $ $ Stela lax elthhokl 14 Gross proceeds paid to an attorney $ 7 State/Payer's state For Privacy Act and Paperwork Reduction Act Notice, see the 2005 General Instructions for Forms 1099, 1098, 6498, and W-20. 18 State
consent Is may not be Mmabatho aner Ihe corponubn rod Mecum (SmrettokkiM 4i and date We ca,Rnt tote am that Welch . Slack tented - • • . NI Sochi imaany number a employer • leendfloodos mot bee Instruction-6) ' ' N . Share- hoiden ._., — Yett ands (meth and day) nd cis the conec
MISC 41 1028061 Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 14 Gross proceeds paid to en attorney 17 State/Payer's Mate ra For Privacy Act and Paperwork Reduction Act Notice, see the 2004 General Instructions for Forms 1099, 1098, 5498, and W-2G. He Stat
VIRGIN ISLANDS FOUNDATION IN room or suite number) L . ) — Name at arson to Math For °facial Use Only E-ma.1 address Fox number 1 Fn. ^ TI Sochi nearby number a To fame tal number of ..,l_ 4 Porlana Inane tax erillted $ 6 Tool amount monad WM This Fcm tea $25.00Q.00 Enter an 1221 In only
boom* $ 11 13 SWISS golden parachute WYmcca $ 10 She tax wt theid $ 10 Crop Insurance proceeds 14 Gross proceeds paid to an attorney $ 17 State/Payer's state no. Copy A For Internal Revenue Service Center RIG With Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2005 G
Entities connected to both Sochi and State/Payer's

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