l.. ". HENDERSON , NV 89 07 4 11 % t y 13 Excess golden poradtme payments $ rz " A 14 Goss pronttch paid to on attorney s Account number Roalcnall he 41 iOlii.. etiraii 7.Y.:*:1/2F-Cot 2nd TIN not D 15 1G Seam tax Mooned $ $ 17 State/Payees state It. 18 State income • $ Fern 1099-MISC