I Mi6cellaneou3 I Income , RECIPIENT'S name, eddrcon. Plated ng apt. n0.), coy, mate, end ZIP code -S 3 001C:tricorn° a rtstoxi bort proem-Kt 7 Koramphym compensation $ $ S 10 Crop Inca:once raecaocls tieW red Isdtb ots paymris 8 SOMIUM payment ?iv of MOW. ot Intanat Account rAimbor (OpticnN) 0