forms. Use Copy A of Form MSS to transmit Copy Ad W-2GU, W2CM. or WM. you must CM &ash the forms to yott Form W-2A,5,11420U, W4CM, or W-201 to the Social Socuilly enpkyoes by February 2 2004. CM see Extension to Immesh Forms W.2 ArtertintstrAcm. Fie Caprice Form W-33.9 and Copyist? Form Vi12AS. to employees

rate hours/unite Ibis period year to as Regular 0.00 3461.54 14230.78 Grose Pay 43,461.54 $14,230.78 Statutory Deductions Federal beans Social Socuilly IM case New 'fat Sane Maine Voluntary Deductions New Yeek volunterydnabiley LESLEY K GROFF Oils period we to dMs Deposits aocounl number ty