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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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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
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agency, or legal Internal Revenue residence in the case of en Service Center individual, Is located In address \Or Alabama, Arizona, Florida, George. Louisiana, Mississippi, New Mexico, North Carolina, Texas, Virginia Martin, -0( 7ssoi Arkansas, Connecticut, Delaware, Kentucky, Maine, Massach
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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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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,
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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
Entities connected to both George W. Bush and CORNELIUS

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