d 2.P coda Form -21,1 1 u.s. Wen islands Wage and Tax Statement Copy D - Fcr Emptcy0t "°""131gbo.00 7 Scald malty bps 9 Advance EIC payment 11 NOOCNOWIN pions a VI Income tax withheld 13099.00 4 Seale cetutky lax wiihrerd 5443.80 tlocttogre lattlirg 120 1 12d 1.51 a Control number Vold El