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rty Status: I a Business Fax Holding Company I 340-7782528 keereaNdebeke Address: WA NAICS Cods --eon O O Dale het:shrilled 12/28/2008 SO W. of OfficosA3ranches: 1 ND,. of Employees: 0 O Om al Lease Referred By: O Advertisement El Current Client 00ther. Cordate Fenno 7 Account 0 so*
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ependent care Innards a Employee's lint name and initial last name Suff. 11 Nonqualltled pans 12a Sae Instructions for box 12 ?, I 13 g1121. W.,'"' liter n n n p-tai I 14 Other 12c ? I 12d 1 Employee's address end ZIP coda leSue Employers state ID number I. 10 Slate wages, lips,
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% 1145,152.00 Page 8 of 17 Clestlas *cough P.O.W. ut.asbay trod Ninicliory of **Bark a Ns Yak Meta
ecurities In/Out of Account .14,386,000.00 -14,366,000.00 Adjusted Previous Account Value 113,518,784.18 101,571,224.30 Dividends, Interest and Olher 'Home 114,111.94 761,166.65 Net Other Activity 0.00 25.00 Net Change in Portfolio 3,514,391.51 14,814,921.68 ENDINGACCOUNT VA Accined Intere
RRATEDCOMMUNKAPONS ()MANCE Clearlas through h O.W. taco ...aftowned stithory of Ow Barra Now Ycelt
A SHOSHAN Net Cash Deposits ad Withdrawals 0.00 4,786,525.39 Adjusted Previous Account Value 3,302,473.14 3,076,742.92 Dividends, Interest and Olher home 79.47 6231.81 Nel Other Activity -2.00 -10.00 Net Change in Portfolio 8,834.11 226,219.99 I I _ Accrued Interest 378,984.46 Estima
overpaid ► 11 Ent r Lhe amount of line 10 to W. Credited to 2001 estimated tax * Refunded 18 •
fil c< (loss) (allach schekile) 11 Othor meorno (aftach acheAde) 12 Total Aud lines 1 Inn:mett 11 i 13 Componeetton ot ~ro nedom trues sto 14 Olher employee selanes and ringes 15 Pension plans, employoe banefits „ 18a Legal Res (attach schodale) b Accounling feos (altach schedule) c Other es
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