00802 t EmpIoyee'o Beton ond ZIP odde 11 Nonquelked plm. 12e Boe Foei, W-365 tratruceono ' S 1817.44 13 myrte p incnt Mrt/ 12b IC 13.21 14 Otaer 12a i i 1121 ! A litim29/ U.S.VirginisBands Form Vage and Tax Statement Copy P • For Empl yer 2004 Departnent or 11w TfCB3Uty • interne!