der. antl 'mice their location Jso The Criprioutirr.!-SJoplemesm: Form. :3. Enter the defendants nine -togi! Social Sectelt; '-u'' bee. 14. Enter New York Slate fdentikostion Number tNYSIO No.). If unknown. leave Wank 15. Enter the FBI Nurnbei ":o alai. !6. Enter the offender's drker's .1ctetse number cu

hat ere required 10 be reported separately to partners „ .. ., /dentily 19 19 Pertner's share of New York modifications (see Instructions) 20 New York Slate additions Number A- Total amount 20a EA- 20b EA- 20c EA- 20d EA- 20e EA- 201 EA- B - New York Stale allocated amount 21 Total addition modritanio

CONFIDENTIAL SDNY_GM_00033162 EF1'A_00143795 EFTA01280313 IT-204-IP i2t)12i Page 3 of 4 Partner's share of New York modifications .'cor;:i 22 New York Slate suotractions Number A - Total amount 22a ES- 22b ES- 22c ES- 22d ES- 22e ES- 22f ES- B New York State allocated amount 23 Total subtraction moddi

this period year to date 1538.46 $1,538.46 Statutory Deductions this puled Federal Income -145.77 Social Security -95.39 Medicare -22.31 New York Slate Income -66.68 Voluntary Deductions Nev York voluntary disability Earnings Statement Period Starting: 03/21/2016 Period Ending: 04/03/2016 Pa

ay Married Tax Override: Federal: Stale: Local: XIOC-XX400C4 hountAmfts 0.00 Statutory Deductions Federal Income Social Security Medicare New York Slate Income Voluntary Deductions New York voluntary &saltily NM Pay this period year to date 1538.46 40384.60 $1,538.46 540.384.60 Period Stalin

rs/units 0.00 this period year to date 1538.46 12307.68 $1,130.46 512.307.6S StatutoiyDeductiorts Federal Income Social Security Medicare New York Slate Income Voluntary Deductions New York voluntarydisabilay this period recto date -145.00 1160.00 -95.39 763.08 -22.31 178.46 -66.50 532.00

LESLEY K GROFF rate 112n/unite thle period year to data 0.00 1538.46 1538.46 StMulory Deductions Federal Income Social Security Medicare New York Slate Income Voluntary Deductions New Yorkvoluntaryft/Maw Na Pay $1,539.46 51,538.46 this period year to date Deposits account number transit/ABA

te hams/tugs this period year to date 0.00 1538.46 35384.58 81,538.46 535,384.58 StemhxyDoduations Federal Income kcal Security Medicare New York Slate Income Voluntary Deductions Nee York voluntary owebiloy Net Pay ilria P44 04 year to date -145.00 3335.00 -95.38 2193.84 -22.31 513.08

Marred Tax Override: Federal: Stale: Local: XXXXX-XXXX rate hourWunits 0.00 Statutory Deductions Federal Income Soda! Sacurily Medicare New York Slate Income Voluntary Deductions New York voluowly disability Net Pay this period year to date 1538.46 24615. 36 $1,538.46 524.615.36 this perio

this period mar to date 0.00 1538.46 30769.20 Gross Pay 91,539.46 530.769.20 pontos,/ Deductions Federal Income Social Security Medicare New York Slate Income Voluntary Deductions New York volunlarydisatdity Earnings Statement Period Staling Period Ending: Pay Dale: 8usness Phone: 09/18)2017

the IRS Unless Requested To Do So BAA For Paperwork Reduction Act Notice, see instructions. Form 8879-PE (2011) PIPA0P0IL II/22/11 EFTA00284490 New York Slate c 1J0 n u(g) 06, New York State E-file Signature Authorization for Tax Year 2011 For Forms IT-204 and IT-204-LL Electronic return originators (ER

ble personal property owned 7 Tangible personal property rented 3 4 2000789 2002909 5 6 70886 70886 7 Part 2 Receipts from: A MCTD B New York Slate C Everywhere Section 210-A.2 1 Sales of tangible personal property 1 2 Sales of electricity 2 3 Net gains from sales of real property 3