lax 20 Locally name i ,tej t .:?..t la n;f 1.; 61tt7 C; 3" • - , , 4 -c. . lc - I ---- ' • r .S bsEsr.:;lanc:§0111#11 . itsisaCA Social Security Number gi p Taxable Mantel Status: Exemptions/Allowances: FEDERAL: 8 STATE: a I Wages. ape. WM/ 00.P. 175323.09 2 Federal income lax Withheld 29092.14