(0U(s1p6vsb4T&a145.92c63.8RCopyright (c) 1995 form software only CPSystems, Inc.
(0U(s1p8vsb4T&a9c63.8RFor Paperwork Reduction Act Notice, see instr.
(0U(s1p10vs1b4T&a16R&a4181.6HFor Official Use Only
(0U(s1p8vsb4T&a13c16r13LIf you are not using a preprinted label, enter in
box 1 or 2 below the identification number you
used as the filer on the information returns being
transmitted. Do not fill in both boxes 1 and 2.
&a91c15.8r91L&l3.69CName of person to contact if the IRS needs more
information
&l8C&a90.99c18RTelephone number
&a13c22r13LEnter an "X" in only one box below to indicate the type of form being filed.
&a127c22r127LIf this is your FINAL return, enter an "X" here &a4598H . . . . . . . . .(0B(s0p10h12v0s1b0Tj(0U(s1p8vsb4T
&a20R&a252.8H(s1B1(sB Employer identification number
&a20R&a1355.6H(s1B2(sB Social security number
&a20R&a2294H(s1B3(sB Total no. of forms
&a20R&a3141.2H(s1B4(sB Federal income tax withheld
&a20R&a4224.8H(s1B5(sB Total amount reported with this Form 1096
(0U(s1p6vsb4T&l4.36C&a46.84R&a305.6HW-2G
&a362H32
&a46.84R&a686H1098
&a722H81
&a46.84R&a1006.4H1099-A
&a1082H80
&a46.84R&a1362.8H1099-B
&a1442H79
&a46.84R&a1724H1099-C
&a1802H85
&a46.84R&a2050.4H1099-DIV
&a2162H91
&a46.84R&a2442.8H1099-G
&a2522H86
&a46.84R&a2775.2H1099-INT
&a2882H92
&a46.84R&a3174.8H1099-MISC
&a3314H95
&a46.84R&a3704H1099-OID
&a3818H96
&a46.84R&a4146.8H1099-PATR
&a4286H97
&a46.84R&a4604H1099-R
&a4682H98
&a46.84R&a4966.4H1099-S
&a5042H75
&a46.84R&a5366H5498
&a5402H28
&l8C&a15c28r15L&l5.33C Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and