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EFTA00175998
raqi Last name DAPHNE L WALLACE P.O. BOX 11184 ST. THOMAS, USVI, 00801 f Rm co'; add sea end ZIP coda 11 Normusliflod piona 2a See Form W489 Inelructiona 4352.37 is sot h fa Trgr r) ri 12b F 4'0.29 14 Other IR° 1 12d / 4 Kern W-2111 u.s. virgin islands Wage and Tax Statement Copy 1-Fo
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