1 FORMS 60,000.00 State Wagea (Box 16) 3,063.96 State Income Tax (Box 17) E1002 EFTA00176007 I .-- I—I I OMB NO. 1645-0008 Leib UVUL . , UUL/, 1 ' 00/ litiD .11 Employee Identification number (EN) " 13-3643429 1 Wages, fps, other compensation 60000.00 2 Federal Income tax vAttiheld 6