5 Modemwore mid Rim 22108.99 11 N0Intailltd Please 2004 lax welteli 1005.00 4 Sodel maarity lr witilvdd 1370.76 mecum, ,,,soimed 320.58 12, Sec Fown 'n,..ructor 1 S 648.18 12c ton Department of M Troz.‘my • Internal Revenue Sem,' For Privacy Act and Pepornork Redact:, Act Mod and Instruten