de h Othr EIN used th0 year Advmo SIC payments 11 Nor:quailed pions 2 •Iloorne tax withheld 1,132.6n,,,nn 4 Scold sect:it/tar wliMld 1722,5 68 Menioeretronemed 12 Defend eompanatfion 13 For thIrd-party al& pay use oriy 14 Income tax wIthhdd by paym of third-patty sick pey I Employer's territedal D numbe