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hode island, Texas, • tont. Virginia, west Virglree vi tin, TX 73301. Alaska. Celeo COnonn, Marla of Columbia. Hawse, Idaho. Meth Indiana, lown, Kansa, Magyars', Peohigan, Minnesota, Mbaourl, Morten& Nebraska, Nevada, North Dakota. °Walleye, Or09:41. South Cartilna, South Dakota, Tennessee, Utah,
l residence In the case of an Individual, is located In Alabama. Adzona. ROOM GEONCI. Louisiana. Mbalseppt. New Marco. North Camino, Sins, Vora Arkansas, COnnectioA Odaware. Rantobey, Mann. kbasecholotts. New Harnpebte, New Jersey. NwiYork, Olio, Po.o/wario. Rhode Island, Vermont, West Walrus Use
pla-nr • • - ifto Farm W.CAt lions . I Sit 3812.08 10 V ez 09:rn. 14. 14 Oho-- • •-•••••••• 3269.68 «Rgwil 764. SE Agl JAMIE I CORNELIUS I . : E2149:9/2 *Cr. 52 %Icy P70PM .7 f7 :171T ' etS‘4 17.W .4.4e ' 14 - 1. -.4 %4;.•:1•2 :Ara; • trip "kv ••• .A.Z1 V•40:' •••'. age 44.Z
iveld 647.14 7 Semite nounty Mu t eckd =Os number .. .. . . 9 Actincoo EC peryrrort 100 / A • EmPbYeC0 fret nemo old NW trot runts JAMIE I CORNELIUS 11 Nonqualll•d pkvil 12 Forn W483 helrumbrz p 4717.21 e Soo I, tut .... , - 18.10 r 14 Other 12e i rei i A4 e Cr,, mi &Dem •rvi 7JP cod
Service Center Individual, Is located in address' Alabama, Arizona, Florida, Georgia, Louisiana, Miss1C4IpPlitialtaxl00. North Carolina, Texas, Arkansas, Connecticut, Delaware, Kentuoky, Maine, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Penney/Limn' Rhode Island, Vermont, WoStillill
- . . . E c r i ; W I ; . ; . _ _ • 1 - • - • • ^ . - - - • - . • • - . - • - • [ CORNELIUS ' : Ealllitepplabblirms.c.74: rj • ykrifp 7.70.12:3'15irr 4. .• .• el} &TAX': e .. ...: arYV13 100 /6" 14S(.142opatN;10 tautta e6w ; 014.,
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
th Carolina, Taxes, Virginia retirement arrangement. a Coverdell ESA, an Archer MSA (Including a Meditcre+ChoIce MSA); certain corporations; and a Arkansas, Connecticut, Delaware, lender who acquires an Interest In secured property or who has Kentucky, Maine, Massaohusetts, reason to know that the pro
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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