10 r A • ..,,by•,. not roma and WWI Lest name DAPHNE L WALLACE P.O. BOX 11184 ST. THOMAS, USVI, 00801 f Employee's addcase end ZIP code 11 NoneNellf,od plans 12a See Form W-386 Imeruollort. S j4225.26 io i c 129.12 13 'wt. "rm ti IIIT,; "Y tl 14 Other Deportment of the C •!. 0.1. AS 12