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. 1646-0006 b Employer identlftcatron number (RIM 66-0567418 1 Wages, tea ether compensation