e and tnittel Form address and ZIP code Lest name onOrAT. U.S. Virgin Islands wage and Tax Statement Copy 1-For VI Spume of Interne/ Revanuo or Copy El-For Employer efeta No. 1590-0008 1 Wages, Spa, other canponerion 41893.44 3 3°3131 3116.06 med'arSrit. o s 9 Advance EIC payment 11 Nonquallted p