ellaneous Income PAYER'S Federal Identification number 'ita. 1.4...74W985, RECIPIENT'S name 6 timing boat proceeds lAnkalmIlmelltere preset $ Sttedlle mama b Reel darderdt et item' ‘•::;:g.; 0 1KW.04V•; ..6?( 4.),I'sa;t riAtY.,T.-Gbn Nommplojte ecappIreetlen $ 1000.00 Street address Oncludng ap