and Paperwork Reduction Act Notice, see the 2004 General Instructions for Forms 1099, 1098, 5499, and W-2G. 15 16 State tax withheld $ 17 StatelPeyees state no. 18 State income S $ ram 1O99-MISC 41.1628051 Departmercoi the 'treasury • Internal RtVOMIC Senice I 06646 EFTA01702213 9595 LI