and Inetruolons, see Form W,385. VI Income tax withheld 36501.0' 5365.00 3 Sante security ciaeii6.5 4 Soda' security tax kt withhe 2462.42 6 Modlowo wageiN. d_thea716.5 Medicare tax vAthhold 575.89 9 Advance DC payment 11 NonquellFred plans 14 Othor a Control nwnbor 22222 ww O OMB No. 16