t
i
1
EFTA00175998
LAW OFFICES OF
148 EAST TEP, STREET
NEW YORK, NEW YORK 10021
[email protected]
SHERYL E. REICH
reichelekowtlaw.COrn
statklenlekOwIlaw.COm
licieknanalekOwtlawcOm
A. Marie Villafaila, Esq.
Assistant United States Attorney
Office of the United States Attorney
Southern District of Florida
500 South Australian Avenue, Suite 400
West Palm Beach, Florida 33401
June 12, 2007
TELEPHONE
FACSIMILE
Subpoenas dated May 31, 2007, to J. Epstein Virgin Islands Foundation, Inc., J. Epstein & Co.,
Inc.; Epstein Interests; and Financial Trust Company, Inc.
Dear Ms. Villafana:
I write to respond to the subpoenas served on the above entities all dated May 31, 2007.
Each of the subpoenas has a substantively identical Attachment to Subpoena describing the
documents requested.
Be advised that J. Epstein & Co., Inc., executed a certificate of dissolution in December
2000 and therefore could not have any documents responsive to the subpoena. Please be further
advised that no entity has any documents responsive to Request Nos. 1, 3, 4 and 5. We are still in
the process of ascertaining whether documents responsive to Request No. 2 exist, and will
provide them to you, assuming they do exist, as soon as we are able to do so. Finally, we have
enclosed for your review all documents we believe to be responsive to Request No. 6, including a
schedule of the corporate directors, board members and shareholders of each entity, to the extent
the question is applicable to each entity.
The documents provided bear the following production numbers, which we note were
placed on said documents for control purposes only and do not appear on the documents in the
normal course:
Schedule of Corporate Directors, Board Members, Shareholders
J. Epstein Virgin Islands Foundation, Inc.
JEVIF 0001
EFTA00175999
LAW OFFICES Or
GEEtALD B. LEE/COURT, P.C.
A. Marie Villafafia, Esq.
Assistant United States Attorney
Office of the United States Attorney
Southern District of Florida
June 12, 2007
Page 2
IRS Form 1096 J. Epstein Virgin Islands Foundation, Inc. 2004
IRS Form 1099 J. Epstein Virgin Islands Foundation, Inc. 2004
IRS Form 1096 J. Epstein Virgin Islands Foundation, Inc. 2003
IRS Form 1099 J. Epstein Virgin Islands Foundation, Inc. 2003
Schedule of Corporate Directors, Board Members, Shareholders
Epstein Interests
IRS Forms W2 Epstein Interests 2006
IRS Form W2 Epstein Interests 2005
IRS Form 1096 Epstein Interests 2005
IRS Form 1099 Epstein Interests 2005
Schedule of Corporate Directors, Board Members, Shareholders
Financial Trust Co., Inc.
IRS Form W3 Financial Trust Co., Inc. 2006
IRS Forms W2 Financial Trust Co., Inc. 2006
IRS Form W3 Financial Trust Co., Inc. 2005
IRS Forms W2 Financial Trust Co., Inc. 2005
IRS Form W3 Financial Trust Co., Inc. 2004
IRS Forms W2 Financial Trust Co., Inc. 2004
IRS Form W3 Financial Trust Co., Inc. 2003
IRS Forms W2 Financial Trust Co., Inc. 2003
IRS Form 1096 Financial Trust Co., Inc. 2006
IRS Forms 1099 Financial Trust Co., Inc. 2006
IRS Form 1096 Financial Trust Co., Inc. 2005
IRS Forms 1099 Financial Trust Co., Inc. 2005
IRS Form 1096 Financial Trust Co., Inc. 2004
IRS Forms 1099 Financial Trust Co., Inc. 2004
IRS Form 1096 Financial Trust Co., Inc. 2003
IRS Forms 1099 Financial Trust Co., Inc. 2003
JEVIF 0002
JEVIF 0003
JEVIF 0004
JEVIF 0005
EI 0001
El 0002-0003
EI 0004
EI 0005
EI 0006
FTC 0001
FTC 0002
FTC 0003-0008
FTC 0009
FTC 0010-0015
FTC 0016
FTC 0017-0022
FTC 0023
FTC 0024-0030
FTC 0031
FTC 0032-0033
FTC 0034
FTC 0035-0036
FTC 0037
FTC 0038-0041
FTC 0042
FTC 0043-0045
EFTA00176000
LAW OVYICCS or
GERALD B. LEarcormer, P.G.
A. Marie Villafaila, Esq.
Assistant United States Attorney
Office of the United States Attorney
Southern District of Florida
June 12, 2007
Page 3
If you have any questions, please do not hesitate to call.
Lilly Ann Sanchez, Esq.
EFTA00176001
Response to Request No. 6 to
Subpoena dated May 31, 2007. to J. Epstein Virgin Islands Foundation. Inc.
J. Epstein Virgin Islands Foundation, Inc.
Corporate Directors/Board Members: Jeffrey Epstein, Cecile De Jongh, Darren Indyke
No Shareholders
JEVIFOLII
EFTA00176002
0 CORRECTED
Patel name, street address, city. stele, Z.
dde, and telephone no.
V:./.1ChTrr.c,
(.3.
vittata t?r,A.g:54
F000Dal?rx:, tnC.)
Wog
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rt. lila4210.4, • nEVI
00:.%02-114lt
1 Rents
S
2 Royalties
tarie No. 1546.0115
2004
roan 1099•MISC
4 Waal Income lox vathheld
Miscellaneous
Income
PAVERS federal kleraleatlon
number
66-0585379
RECIPIENT'S name, address, and ZIP code
RECPENT'S ldontifirsetion
number
6-01 3 6 64.9
I, AUL HOFFPIrsti P.C:
2nd 11N not,
C
3 Other Income
a Fishing boat proceeds
S
7
tionernployes oompereatNn
6 wddhat ird healb two min
Copy C
For Payer
or State Copy
ri Streatham payments In lint 44
dividends a intereSt
2c I Mt .
9 Payer medi Ord sites of
10 Crop UM /no, proceeds
15,010 a rrOT1 or axmornet
(necklets to a buyer
(reeplint) for resole > 0
15
Form 1099•MISC
13 Excess go den porocitute
payments
la State tax withheld
$
0 VOID
0 CORRECTED
PAYER'S name, =eel address. city. sone. ZIP °ode• and telephone no.
14 Gross proceeds pad to
an attorney
17 State/Payees suite no.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2004 General
Instructions for
Forms 1099,
1098, §498,
and VI-2G.
18 Stew Inconlo
Dopaltrnent of Ihn Treasury- Intend Revenue Service
•
I Rents
PAYERS Federal IdendkotiOn
timber
RECIPIENT'S IdOnWICalithl
number
RECIPIENTS name. address, and ZIP code
Account number (optima
2 Royalties
$
3 Other Income
S
OMB No. 1645.0116
2004
Form 1099-MISC
4 Raul frame tax withheld
6 Meath anitethe eta opted
Miscellaneous
Income
6 Fishing boat proceeds
Copy C
For Payer
or State Copy
7
Noncolplere companion
S
9 Payer male &ea sates or
15,0(0 or intro of ecratimar
products to a buyer
(reelable) for ogee t* 0
0 Substitute meats h Ike ni
dieends or Knot
11
10 Crop Insurance proceeds
$
3
Excoss golden parachute 14 Gross pomade paid to
PaY11111.1
en attorney
$
ts State le vAthhced
ii
17 State/Payees ;tato ma
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2004 General
instructions for
Forms 1099,
1098, 5498,
and W-2G.
18 Suite Inoonm
$
S
Form 1099-MISC
LIEVIF003
Department of the Treasery
sterna'. Ramo SeMco
EFTA00176003
1.
Oo ?Int 3%
OW ic, IWO. F 1 VO
ecnn logs
caccivrant of the 'Ream
• teem* ninon &Mee
Annual Summary anti Transmittal of
US. infommtion Returns
2003
PILER.8 name
i
(J. EPSTEIN VIRGIN ISLANDS FOUNDATION IN
Street address (Including room or suite number)
6100 RED HOOK grss 1 133
City, state, and ZIP code
i
s ST . THOMAS / USVI
00802-1348
J
. )
Nome of parson to contact
Telephone number
For Official Use Only
JEANNE
(340) 775-2525
smal address
Pox number
(340) 775-2528
•
Il
i,
En
I Enpbyer Idertfattiorl 'Viable 1
66-0585379
2 Sochi eaturlW number
a Total number Of
forms
1
4 Vodral Mara VN eithheld
$
6 Total mann repotted ail% thIS Form1026
`$25r 000. op
,_
Enter an "X" In only one boa below to indicate the type of form being filed.
If this is your final eturn, enter en where . . . le• 0
W.29
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•
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•
969
Return this entire page to the Internal Revenue Service. Photocopies ere not acceptable.
Under penalties of penury, I dooltro that I have examined the return end accompanying docUmarda, end, to Ihn ban o1 my lowtoladoo and belial, they arc Inio,
Oormot, and.ComplOtO.
S:glItthlrel ►
Instructions
FEB
Purpose of form. Usg,th
to tran
Forms 1099,
1098. 6498, and W-2GZff
tie
avenue
ice. Do not
use Form 1098 to trunsm
Ig
erotically. For
magnetic media, area Form 4804,T
5),fiermation
Returns Reported Magnetically; for electronl
QLAtSlpns, eaa
Pub. 1220, Speolfloations for Filing Forma 1098, 1 Ki6498 and
W-20 Electronically or Magnetically.
Who must file, The name, address, and TIN of the filer on
this form must be the same as those you enter in the upper
left area of Forms 1099, 1098, 6498, or W-20. A filer Includes
a payer; a recipient of mortgage interest payments (Including
points) or student loan Interest; an edumtonal Institution; a
broker; a barter exchange; a creditor; a person reporting real
estate transactions; a trustee or Issuer of any Individual
retirement arrangement, a Coverdell ESA, an Archer MSA
(InoludIng a Medlcare+Cholce MSA); certain corporations: end a
lender who acquires an Interest in secured property or who has
reason to know that the property has bean abandoned.
Preaddrossod Form 1096, If you received a preaddressed Form
1096 from the IRS with Package 1099, use It to transmit paper
Forme iove,1098. 5498, and W-20 to the Internal Revenue
Service. If any of the preprinted Information le incorrect, make
corrections on the form.
If you are not using a preaddreesed form, enter the filer's
name, address (including room, suite, or other unit number), and
TIN In the spaces provided en the form,
ON. #0.2
Title
isdid r 74.
When to fife. File Form 1096 with Fonns 1099, 1098, or W-2G
by March 1, 2004. File Form 1096 with Forms 6498, 5498-ESA,
and 6498-MSA by May 31, 2004.
Where To File
Send all Information returns filed on paper with Form 1036 to the
following:
If your principal business'
Use the followIrts
office or agency, or legal
Internal Revenue
residence In the case of an
Service Center
Individual, Is located in
address'
Alabama, Arizona, Florida, Georgia,
Louisiana, Miss1C4IpPlitialtaxl00.
North Carolina, Texas,
Arkansas, Connecticut, Delaware,
Kentuoky, Maine, Massachusetts,
New Hampshire, New Jersey,
New York, Ohio, Penney/Limn'
Rhode Island, Vermont, WoStillill
Illinois, Indiana, Iowa, Kenna,
Michigan, Minnesota, Missouri,
Nebraska, North Dakota, OWahoma.
South Carolina, South Dakota,
Tennessee, Wisconsin
. Austin, TX 7330
Cinoinnati, OH 4599
Kansas City, MO 6491
For more Information and the Privacy Act and Paperwork Reduction Act Notice,
see the 2003 General Instructions for Forms 1090, 1098, sage, and W-2O.
Oat. No. 144000
Form 1096 tear
JEVIF004
EFTA00176004
'
.
0 VC
`i
0 CORRECTED
42/eornia Mb street oddrelit city, state. ZIP cobs, bad telephone no.
1 Rents
voAhtiCSD UDWATION
(J. 1:103TEIV
Erltac::.
roumcATios
slot) fan :;0011. QTRa f OS
.7AGKAS, van 00602-1348
a Rosales
OMB No. 1545 011R
2003
Form 1099-MISC
4 Racal Income lox withheld
S
Miscellaneous
Income i
3 Myr Income
S
PAYER'S federal identilioation
number
66-86'35379
PRCIPIENT'S name, address. finclualnp apt no.). thy, elate. end ZIP code
RECIPIENTS Ideraircotton
number
66-0436649'
5 Fishing boot proceeds
Ntellcal snd health amp:rots
State Copy
or Extra
File Copy
0011.074104 V.O.
•
B02C (171::
CHIVALOTTP, .204PiLiEt, •
Account number (optima
00804-0970
7 N000rnpcytrt comp0ODIAIon
$25,000.00
8 Substerte portents In Intl of
(Wands or Interval
15
Fcart 1099-MISC
9 Pow retie direct soles of
3533) or more of consumer
srodircts to a boyar
bacblent) for rook in
10 Crop lnsumnoo premeds
13 Excess goidernicachuni
payments
11 Gross proceeds Fold to
on stormy
$
17 staterPnyer's Mote no.
to State tax tnehh9ld •
13 State income
$
K VOID
•D CORRECTED
Department or the Treasury - Internal Revenue Benno
rnT.Ica DIOT/111,OWV4M.LAIIIIIEN Gay. %KUM, tar woe, fatly varT131.11K tie.
PAYER'S Federal Identification
number
RECIPIENT'S IdanantatiOn
number
RECIPIENT'S name, &knees. °Mud ng apt. MO), oily. Mote, end ZIP coda
I
Rents
$
Royettlos
$
3 Other Income
$
8 Visiting boat monads
ohitt No. 1545:0115
2003
Fano 1099-MISC
. 4 Fa ersol bane tax ettUiteld
S
'
.
1
Miscellaneous
Income . 1
7 Nonomptom conlpansallon
$
$
6 WILD andWMcm plitrAIS
Substitute open In feu of
dM4trds a Interest
0 Paw troda dirfitt soles cf
55033 or more ci consumer
DOCUCIS to a brier
Ifaelrleob for resole in 0
lit
13 Escape gofdcri parachute
payment",
10 Crop Insurance oroceods
S
12
Account number ktptlOnC6
15
14 Gross proceeds paid fo
en attorney
State Copy
or Extra,
File Copy
16 State tax s1thhold
$
17 State/Macs state no.
18 State Income
Fc,,,,1009-rorsc
JEVINE5
Depanmont of the Tmancy • InteMN Rtnanue Service
EFTA00176005
Response to Request No. 6 to
Subpoena dated May 31 2007. to Epstein Interests
Epstein Interests
No Shareholders, Board Members or Corporate Directors
E1001
EFTA00176006
rb,,Empleyer,Identlfloation number (Elt0
13-3643429
'.
1 Wages, lips, other canpense5on
60000.00
2 Federal Income tax withheld
6065.04
o Employers name, address, and ZIP code
3 Sodel security wages
60000.00
4 Social security lax wIthhard
3720.00
457 MADISON AVENUE
NEW YORK, NY 10022
6 Medicare wages Ind Upe
60000.00
6 M00ktire tail withheld
870.00
7 Social secudty Ups
8 Allocated rips
d Employee's social security number
9 Advance E1C payment
10 Dependent care benelitt
a Emp:oyes's first name and Initial
Last name
Sufi. 11 Honour:dined plan
12o Soo Instructions for box 12
•
.
13 tan
° Ill
Waterer
..1,2b
n n
14 Other
12c
.
12d
.
f Employee's address and ZIP code
rtRIWWWgitTag-WL,
15 612ga
Emp'cryer's state ID number
i
I.
10 Stale vines, Ups, Mo.
17 State Income lax
15 Local new, tips, Mo.
11) Local Income tax
20 Isr.ely name
Form W-2
Wage and Tax
Statement
Copy D—For Employer.
• Kt..
2006
Department of the Treasury—!ntemai Revenue SonAce
For Privacy Act and Paperwork Reduction
Aot Notice, see back of Copy D.
**********************************
TOTALS
w*****************************
For: Batch No. 2006/4/00859
1 TOTAL EMPLOYEES
For: Company
66/LMB
31.20 NYDD
(Box 14)
1 FORMS
60,000.00 State Wagea (Box 16)
3,063.96 State Income Tax (Box 17)
E1002
EFTA00176007
I
.--
I—I I
OMB NO. 1645-0008 Leib
UVUL
. , UUL/, 1
' 00/ litiD
.11 Employee Identification number (EN)
" 13-3643429
1 Wages, fps, other compensation
60000.00
2 Federal Income tax vAttiheld
6065.04
"/0 EMployees name, address, and ZIP code
3 Social security wages
60000,00
4 Social seaway tax wleitaid
3720.00
457 MADISON AVENUE
NEW YORK, NY 10022
0 Madame, wages and dps
60000.00
0 Medicare tax withheld
870.00
7 Social security ttpe
0 Allocated Ups
d Employee's &eclat security number
451-11-5768
9 Advance EC payment
10 Dependent are benefits
c Employee's Fret name and Initial
Last name
Suff.
LESLEY
GROFF
11 Nonquallead plans
,132a See Instructions for box 12
I
120 OAK STREET
NEW CANAAN, CT 06840
13 cri.,1. :cas.
Vithe
n n. n
Ph
.
I
14 Other
12c
?
1
I
31.20 NYDD
12d
i
I Employee's address and ZIP Code
10 MS
Employees state ID number
NY
1 13-3643429
10 State waged, tpa, etc.
60000.00
17 State income tax
3063.96
13 Local wage,, tips, est.
I
10 Local Income tax
20 Leanly ntrAe
RmliA
ej MlageandTax
r mAL Statement
Copy D—For Employer.
t% .
2006
Department of the Treasury—Internal Review. Service
Fe Privacy Act and Paperwork Reduction
Act Notice, Gee bock of Copy D.
a Control meteor
Vold
OMB No. 1545-0)08
b Employer IdenUtIcatIon number EIN)
1 Wages, tips, other compensaton
2 Federal Incans tax wIthhekt
o Employees name, address, and DP coda
3 Social security wagoe
4 Sodal security tax withheld
6 Medicare wages and tips
0 Medicare tax withheld
7 &odd security tips
0 Allocated 'pa
d Employee's social security 'lumbar
9 Advance EIC payment
10 Dependent care Innards
a Employee's lint name and initial
last name
Suff.
11 Nonqualltled pans
12a Sae Instructions for box 12
?,
I
13 g1121.
W.,'"'
liter
n n n
p-tai
I
14 Other
12c
?
I
12d
1 Employee's address end ZIP coda
leSue
Employers state ID number
I.
10 Slate wages, lips, etc.
17 State Income tax
10 Local wages, Ilps, etc.
19 Local income fax
20 Laxity rams
Wage and Tax
West
Statement
`For Employer.
2006
Department of the Treasury—Internal Roicnie Service
For P#vacy Act and Paperwork Reduction
Act Notice, see back of Copy D.
E1093
EFTA00176008
, a, Centre number
0001
66/LMB
VOW
a
omeNo.iss-moeLM8
0001
la Employer identification number (Elio)
13-3643429
1 Wages, ape, other compfentalee
60000.00
2 Federal Income tax wahheld
6834.27
G EMOWArsb&MkOMION,WdZIPON20
3 Social security wages
60000.00 •
4 Soda) security tax withhold
3720.00
--457 MADISON AVENUE
NEW YORK, NY 10022
s Medicare wages and tips
6000000
8 Medicare lax withheld
870.00
7 Social security Ups
8 Allocated tips
d Employee's social security number
451-11-5768
9 Advance ESC payment
10 Dependent cam Ninths
e Employee's Eat name end Initial
Last name
LESLEY
GROFF
11 Nonquailled plans
12e See instructions for box 12
I
I
120 OAK STREET
CANAAN, CT 06840
13trx, .... Other
OM
F it Pi
n
NEW
12b
i
I
14 Other'
12o
i
I
1 Emot/ea address and ZIP coda
28.80 NYDD
32°
I/
15 Fa
Employer's state ID number
NY 1 13-3643429
to Slate wegek lips, eta.
60000.00
11' Side Imam tax
3173.41
18 Leal mpg, fps, att.
19 Local Income tax
20 Leaky neve
2
Wage and Tax
Form Wes
Statement
Copy D—For Employer.
2005
Department of the heasury—Intemel Revenue Service
For Privacy Act and Pepenvorli Reduction
Act Node*, see back of Copy D.
a Control number
yeti O
OMB No. 1515-0000
b Employer Identification number (EIN)
1 Wages, lips, other corratematIon
2 Federal Income lax withheld
c Employees name, address, and ZIP code
3 Sodel security wages
4 Social security tax weNkeld
6 Medicare wages and tips
6 Medicare tax withhe'd
7 soda security ups
8 Allocated tips
d Employee's social security number
9 Advance DC payment
10 Dependent care benefits
e En-croyee's first name end Inifel
Last name
ft Nonerealico pions
g22, See Instructions (or box 12
I
I
13 tr,ii
;Ira
WA"
n n
I-1
12b
i
I
14 Other
12c
I
I
I Employee's address and ZIP code
16 sale
Employer's state ID number
J
10 Slate wages, ups, etc.
17 State Income tax
18 Local wages, Ice, ales.
19 Local income tax
20 Lotaley name
t
I
Wage and Tax
Form1111c Statement
Copy El—For Employer.
2005
Deportment of the Treesury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see beck of Copy D.
E1004
EFTA00176009
co ris.4
-"r
696 9
OMB Ne. 15484109
Fe..1096
Deposing,la the Mown
Internal Revenue Berate
Annual summary and Transmittal of
U.S. Information Returns
2(305
(Rev. riven 2055)
I FILER'S name
1
Street address (Including room or suite number)
457 MADISON AVENUE
City, state, and ZIP code
LNEW YORK, NY
1 0 02 2
I
Name of person to contact
Telephone number
For Official Use Only
Email address
Fax number
Oli
( )
I
EmptoyeriangiCation hunter
11-16 41429
2 Soclalsecuitty number
3 Total number 04
forms 1
4 Federal income lax withheld
$
0 00
5 Tool asothint /Opened well this Fenn 1091)
$
66-7-3 0 0
Enter an X" In only one box below to indicate the type of form being flied.
If this is your final return, enter an "X" hero .
.
. P. 0
W-20
32
0
1098
81
0
1008 0
70
0
1098-E
84
0
1098-T
03
•
10984s
03
•
10930
79
0
1099.0
es
0
1003.CAP
75
K
109,050
91
0
1000-0
86
0
1009+I
71
W
loaSINT
92
0
10994.70
93
0
100551450
95
CI
10994310
96
K
10994Wri
. 97
MI
1003.0
31
0
101143
Se
Ill
1019-S
75
N
10955A
94
0
5490
28
II
5498-ESA
72
0
549894
27
K
YERS' COPY
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Under ponoltios of pertUry. I declare that I have examined this return and accompanying documents. and, to the best 01 my knowledge and ballet they are true.
correct, and complete.
Signature •
Title e
Date •
Instructions
Purpose of form. Use this form to transmit paper Forms 1099,
1096, 5498. and W-2G to the Internal Revenue Service. Do not
use Fon 1096 to transmit electronically or magnetically. For
magnetic media, see Form 4604, Transmission of Information
Returns Reported Magnetically; for electronic submissions, see
Pub. 1220, Specifications for Filing Forms 1098,1099, 5498 and
W-20 Electronically or Magnetically.
Who must file. The name, address, and TIN of the filer on this
form must be the same as those you enter in the upper left area
of Forms 1099, 1098, 5498, or W-2G. A filer includes a payer; a
recipient of mortgage Interest payments (Including points) or
student loan Interest; an educational Institution; a broker; a
barter exchange; a creditor; a person reporting real estate
transactions; a trustee or issuer of any individual retirement
arrangement, a Coverdell ESA, an HSA, an Archer MSA
(Including a Medicare Advantage MSA); certain corporations;
certain donees of motor vehicles, boats, and airplanes; and a
lender who acquires an interest in secured property or who has
mason to know that the property has been abandoned.
Preaddressed Form 1096. If you received a preaddressed Form
1096 from the IRS with Package 1099, use It to transmit paper
Forms 1099, 1098, 5498, and W-2G to the internal Revenue
Service. It any of the prepdnted Information Is Incorrect, make
corrections on the form.
If you are not using a preaddressed form, enter the filer e
name, address (including room, suite, or other unit number), and
TIN In the spaces provided on the form.
When to file. File Form 1096 with Forms 1099, 1098, or W2G
by February 28, 2008. Ale Form 1096 with Forms 5498, 5498-
ESA, and 5498-SA by May 31, 2006.
Where To. File
Send all Information returns filed on paper with Form 1096 to the
following:
It your principal business,
Use the following
office or agency, or legal
Internal Revenue
residence In the case of an
Service Center
individual, is located In
address
`err
Alabama, Arizona, Florida, Georgia,
Louislarta, MISsiafiPa
rQ°,
North Carolina, Tema,
Austin, DC 73301
Arkansas, Connecticut, Delaware,
Kentucky, Maine, Massachusetts,
New Hampshire, Nekv Jersey,
NewYork, OMo, Per nsylvani
Rhode Island, Vermont, West
•
Cincinnati, OH 45999
Illinois, Indiana, Iowa, Kansas,
Michigan, Minnesota, Missouri,
Nebraska, North Dakota, Oklahoma,
South Carolina, South Dakota.
Tennessee, Wisconsin
Kansas City, MO 64999
4
1
I
For more information and the Privacy Act and Paperwork Reduction Act Notice,
see the 2005 General Instructions for Forms 1099, 1098, 5498, and W-2G.
E1005
48.0971237
Form 1096 (Rev. 3-2005)
EFTA00176010
9595
K Vr
PAYERS name, street address, diet, state DP
457 MADISON AVENUE
NEW YORK, NY 10022
number fi:Ogi,,).7d6AUS6,1W,
PAYER'S Federal Identification
13-3 64 34 2 9
RECIPIENT'S name
U
0 CORRECTED
and telephone no.
RECIPIENTS Identlacation
number .f6IVAficittit
tit;:,
13-2842281
ASSOCIATES
Street address anoludhg apt. no.)
110 EAST 59TH STREET
City. slate. and ZIP code
NEW YORK, NY 10022
Account melba( (see het: hoes)
/A.Vbifiggaen786ZWI4
1 Rents
$
Royalties
$
3 Other Income
6 Adam, boat proceeds
6673.00
OM.. to. 1645-0115
2005
Fon 1099-MISC
4 Federal Income tax witteld
Miscellaneous
Income
9 Payee made Mad sales of
$5.000 or more of construe
omit& b a burr
(recipient) for male e
15a Section 409A deferrals
$
Fowl 1099-MISC
Do Not Cut .or Separate Forms on This Page
— Do Not Cut or Separate Forms on This Page
Sb Sscaon 409A Income
$
11
14 Grose proceeds paid to
an attorney
13 Eixese golden parachute
PeYments
$
18 State tax ,eleNteld
$
$
8 Medial aid beat cam ewmtett
$
8 Subaqua paned. la Ilea of
Olviterati or Merest
v
4e
; ;E-:
10 Crop Instrance proceeds
$
17 State/Payees state no.
Copy A
For
Internal Revenue
Service Center
Ale with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2005 General
Instructions for
Forms 1099,
1098, 6498,
and W-20.
18 State Income
Cat No. 1442SJ
Department of the Treasay • Internal Revenue Service
9595
0 VOID
0 CORRECTED
PAYER'S name. street address. dbl., stale. DP code, end telephone no.
RECIPIENT'S name
Street address (including apt n9)
15a Section 409A deferrals
$
Sb Section 409A Income
1 ReMs
$
2 Royalties
3 Other Income
OME. No. 1545-0115
201:15
Fan 1099-MISC
4 Weal Nome tax withheld
Miscellaneous
Income
6 Fishing bad proceeds
8 Metleated bah pre pawls
trIVA4NR,74"WeiVX.:Kitlit
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
7 flonernployee compare 6 Substitiell oirmala CI
•X.M
Ari.jek,
&beads or mast ,yar,e;fi,
*Y4N-YragIOYANi,V4,1:;,:Aif‘
$
9 Pow tide direct salts of
10 Crop Insurance proceeds
95900 or ride or consumer
products to a buyer
(redolent) tor rube P.
13 Excess gcklen parachute
payments
$
$
Stela lax elthhokl
14 Gross proceeds paid to
an attorney
$
7 State/Payer's state
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2005 General
Instructions for
Forms 1099,
1098, 6498,
and W-20.
18 State Income
$
$
Form 1099-MISC
C I. No. 14425J
Department of the Treasury - mama' Revenue Saab,
EDO
6Do Not Cut or Separate Forms on This Page
—
Do Not Cut or Separate Forms on This Page
EFTA00176011
Response to Request No. 6 to
Subpoena dated May 31, 2007, to Financial Trust Company, Inc.
Financial Trust Company, Inc.
Corporate Directors/Board Members: Jeffrey Epstein, Cecile DeJongh, Ghislaine
Maxwell
Shareholders: Jeffrey Epstein
FTC0001
EFTA00176012
tp0 NOT STAPLE OR FOLD
fa Conhor number
•
39933
For Official Uert Only P
0148 No. 1&45-0009
b
•
94149
Mary
943
94444
Kind
of
IN
1 Visas, ups, other compensation
770439.00
2 Income tax withheld
128484.00
Hahld.
Meolcaro
Th
ny
Payer
of
9,6„„.
sic
po
ay
3 Sode securty wages
l
i
587136.84
4 Social acuity tax withheld
36402.49
0 Totel number ol Forme 44
11
0 Establishment number
5 Meeker° wageo and lips 10384.62
e medlars tax withheld 11750.58
G timpbyet Idenasentilon number (E1N)
66-0567418
7 Social unitary tpe
7
f Empbyert name
9 Adnonop EIC payments
10
1 ... 6100 RED HOOK QUARTER B-3
11 Nenquailned plena
12 Dsferradcompanaellon 39945.62
ST. THOMAS
00802
13 For liardporty Wok pay us* orry
9 Employer. widows and ZIP code
14 Income tax withhold by payer of third-pony sick pay
h other EN used thb year
If
V
I Employer's terniodni IO number
A
Contact pennon
JEANNE 13RENNAN
Telephone number
(340 ) 775-2525
For Mel Use Only
Eunati tddrets
F 110 ) 771-2528
Undor parolees of pottery. I
they are We, COITOCA, o
Signature P
oat Tox Department
roPanYin2 documents, and, to the best or my knowledge and belle!,
oleo re
Fears W-3SS Transmittal of Wage and Tax Statements
2006
Contact the Division of Revenue and Taxation. Commonwealth of the
Northern Marlene Islands, for the address to sand Copy 1 of
Forms W-20M and
Shipping and mailing. If you file mote than ono typo of for, please
group forme of the same typo with n separate FORM W-3SS for oach
typo. For example, send Forms W-2GLI with ono For WSSS and
Forms W-2AS with a second Farm W.SSS. Forms W-2AS,
go. Send the vole
W2CM, or W-2V1 era printed two forms to a
page of Copies A and 1 even if one of the fo
Prepare and file Forms W-2 either alphabetic°
names or numerically by employees social so
staple or tape the forms together and do not fol
in a flat mailing.
General Instructions for Forms W-
W-2GU, W-2011I, and W-2VI
coo' V'
cAta
Fumiehing Coates El and C to omeloyeea. Furnish Cop
era of
1,o
Fame W-2AS, W-20U, W-2CM, end *0/I to your °mato
y
January 31, 2007. If employment ends before December 0
0, you may
furnish the copies any time after employment onde but no la do than
January 31, 2007. 0 the employe* ask. for the form, (umbl t‘ or her the
completed copies MUM 30 days of the requost or Vitas SO days of the
last wage payment, whichever Is Ater. If an employee loan a for, write
`REISSUED STATEMENT' on the now copy (unless It was furnished.
aleotronically), but do not send Copy A of the reissued statement to the
SSA, Employers are not prohibited (by the Internal Revenue Code) from
charging o foe for the Issuance of a duplicate Form W-2AS, W4GU,
4-2014, or W-2V1.
Ocoorknonl Of Ontr000Vty
WomollievonunSento
Extension to famish Forms W4 to employees. You may request an
extension of Eme to furnish Forms W-2 to employees by °ending a tenor to:
IRS Enterprise Computing Canter—MerUnsburg
Information Reporting Program
Attn: nctonalon or Time Coordinator
240 Mural Drive
KonmaysvIllerWV 25430
Mall your latter on or before the duo date for rembhMg Forma W-2 to
employees. It must Include:
• Yolk name and address,
• Your employer Identifkatton number (81N),
• A statement thel you are requesting an extension to furnish 'Forms W-2"
to eMptoyees,
• Reason for delay, and
• Your signature or that of your authorized agent.
Unciollyerablo forms. Keep for 4 wpm any employes/ copies of Forms
W-2AS, tli.2QU, 4.20M, or W4VI thst you triad to deliver but could not.
Do not send undeliverable Forma W-2 to the SSA.
Calendar year basis. Base ell entries on Forms W.P.AS, W4GU, W.2CM,
W.2V1, and W4SS on a calendar year. Usa the correct year form.
Electronlo reporting. If you are required to No 280 or more Forrhs W4AS,
W-2GU, W-20M, or W-2VI, you must file thorn eleolrOttcalty. You can get
sptcllicatione for Ring this Information otactronlealty by Waiting Social
Security's Empityer Reporting Instructrons and information websria at
vntnksocrelsecurigsgoviemployer o
an SSA Employer
SOnioati Liaison Offloor (EISLO) at
for tie U.S. Virgin Islands
or 510-9704247 for Guam and
. 93A will no longer accept
any typo of physical media (Magnetic tape, cartridge, diskette, etc.)
subrrieetons of Fenn W-2 reports.
Page 3
FTCOUG2
EFTA00176013
•
in Control number
22222
Vold
OMB No. 1543-0000
b Employer Ideal/Icarian number (PIN)
66-0567418
c Employers mum oddrsao. and ZIP code
6100 RED HOOK QUARTER B - 3
ST. THOMAS MIS
00802
d Employee's to*& smelly number
150- 46- 4746
Prsnfirtat name and initial
6501 RED HOOK PLAZA STE.
PMB 201
ST. THOMAS, VI, 00802
ZIP
do
Form
Copy 1-For VI Bureau of Intorno] Revenue or Copy D-For Employe(
SUP,
1 Wages, Spurn dna( componsetion
2 VI income lax withheld
95701.00
10920.00
O
8"Ini"c"
58n00.00
a
Sock) security
IFel l 364410
6 Medicare vmmanchloa
D./ 1. o c e
7 Socinisocunty tips
0 Advance EIC payment
la RV.
id Other
Wynn
"dyer
n
""It52.66
12.1 Se0 FolynU c311n. 98uolPorn
S
I ,L93.31
r
g2d
W-2111
U.S. Virgin Islands
Wage and Tax Statement
2006
Deponmerd or rho Treasury—internal Revenue SarvIce
For PrNeoy Act and Paperwork Reduction Act Notice
and InatructIons, see Form W-35s.
a Control number
2E222
Vold O
OMI3 No, 1649.0008
b EmpIoyer Idontirkelion number (ON)
66- 0567418
o Employer's name. address. and ZIP coda
6100 RED HOOK QUARTER B - 3
ST. THOMAS
, 00802
1 ver.900...mumpoomft
44771.16
3 Social troo.dity Maw
.
49713.02
2 Vi income Box withheld
4649.00
4 Social murky tax vdtnhali
3082.21
6 MOdlOara wages end tips
49713.02
7 Eyed aocurity lips
d Employees lipoid partly number
580-03- 9952
O FrrPlogni000ArWROCAdWMW
LaCt name
LEON A
P.O. BOX 503032
ST. THOMAS, VI, 00805
0 Advance BC payment
10
Form
a address. end ZIP codo
W-2111
CASEY, SR.
U,S. Virgin Islands
Wage and Tax Statement
Surf. 11 Normuolified plans
Medicare tax withheld
720.84
Agi
12a See Form W-380 inetructSna
S
4941.86
10 lat,Itry
Thkrtfq
jar.
Iri
rid
rl
14 Other
2006
12d
2b
C
I 294. .58
.
Deportment of the lheasury—tnlamor Revenue Service
For Privacy Aot hd Popenvork Reduction Act Notice
and Inottocifonp, sea Form W-33S.
Copy 1.For VI Bureau of Infant& Revenue or Copy D-For Employer
F-0003
EFTA00176014
e Control number
22222
OMB No. 1543-O300
b Employer IdortliPoetton (\ember (cm
1 wage°, Ups, otheraynpausion
66-0567418
• Employer's nomo, address, and ZIP code
6100 RED HOOK QUARTER B-3
ST. THOMAS
, 00802
d En 580
loyeelt so
13-4697
Clel security number
arnagilettf tarns and Inkiel
Last norno
CORNELIUS
6501 RED HOOK PLAZA
FMB 201
ST. THOMAS, VI, 00802
t E
d
2le coda
SO.
Wain]
U.S. Virgin Islands
Form
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy D-For Einp!oyor 2006
Deportramt of the Trassury—Intornst Remade &mos
For Privacy Aot and Paperwork Reduction Act Notice
and Inetruolons, see Form W,385.
VI Income tax withheld
36501.0'
5365.00
3 Sante security ciaeii6.5
4 Soda' security tax
kt
withhe
2462.42
6 Modlowo wageiN.
d_thea716.5
Medicare tax vAthhold
575.89
9 Advance DC payment
11 NonquellFred plans
14 Othor
a Control nwnbor
22222
ww O
OMB No. 1646-0006
b Employer identlftcatron number (RIM
66-0567418
1 Wages, tea ether compensation
149125.46
2 VI Income tat withheld
28186.00
o emplowee name, addles; end VP code
6100 RED HOOK QUARTER 8-3
ST. THOMAS
r 00802
3 Social aeourIty wages
94200.0C
4 Scent security tax ytWihee
5840.40
8 Modloara wapiti, end tips
159225.4E a M""ra t"iti
WliW
2 3Old 7.32
7 80clal SeCureer Upo
QV
d Employee; weld comity number
58D-06-1538
9 Advance BO payment
•
10
17
a Employee's first an and Intel/
Last name
sue.
CECILE R
DE JONGH
P.O. BOX 6361
ST. THOMAS, VI, 00801
t Emote oo's addr s and
code
11 Womanlike pans
174 Sc. Form W-3.98 hattuctIons
IC 1184.73
1s1
repeori
:roe
N
Lig
feuIs
110000.00
120 I
14 Other
,Rd
Ag
I r
U.S. Virgin Islands
Form 1,41-2V I Wage and Tax Statement
Copy i•ror VI Bureau of Internal Revenue or Copy D-For Employer 2006
Department of the Treasury—Internal Revenue Setv/oo
For Privacy Act and Paperwork Reduction Act Betio:
and Instructions, ma Form W-3S.S.
FTEDD04
EFTA00176015
2 Control nuntoor
22222
Void
OM No.1545.0308
b Employer klimftallon number (EIN)
66-0567418
• EmplOyer's nom caldrons, and 21P code
6100 RED HOiiiiiiiTER ES -3
ST. THOMAS
, 00802
d Employee's =Al security minter
090-44-3348
walajtm,Dthwcimpipmmo
241,021.3(
2 VI Income Wk withheld
65182.00
4 Social socunly tax wShltdd
5840.40
Sorge security wages
94200.0C
a ModlOara Warntini
3c
7 Social socwtty tips
0 Advance BO payment
12511i7gandhmm
umaktiN
6100 RED HOOK, SUITE 2
ST. THOMAS, VI, 00802
I Em
s adores' end ZIP code
Fenn IN-2111
U.S. Virgin Islands
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue, or Copy 0-For Employer
Sufi 11 Nonquellfed plans
6 laledleeto toe withhold
a494.81
10
22a See I
C
13
■
per
■
14 Other
2006
1211
ern W-$55 In:erection
3.02 1.. 2 8
120
2d
t
A
Depiterwint Male Troastury.../memal Revonuo &Mee
For Privacy Act end Paperwork Reduction Act Notice
and Instructions, see Form W-3$5.
e Control number
22222
Vold O
MG No.1545-O008
b Employer Iderillacadon number (ERE
66-0567418
• Employer's name, addpr.4, and ZIP code
6100 RED HOOK QUARTER B-3
ST. THOMAS
00802
Wages, tiP/,0111v compareelan
20380.75
2 VI Income nix withhold
2264.00
4 Social tectety tax withhdd
1263.61
•
Medicare lax Withheld
295.52
d Employee's social sucurity number
580-23-1452
o Employee'. that name and Mkt
Lint name
TEQUASI O
HENDRICKS
PO BOX 672
ST. JOHN, USVI, 00831
I Em i eels addro
n a IP code
J
3 Redd etcority were
20380.75
6 Modesto taws old tips
20380.75
11 Nonqualfled plan
13l'i
Iva
14 Other
ri
221 Ste Form W-35$ In/toolono
I
22b
12c
I
12d
Form W-2V1
2006
U.S. Virgin Islands
Wage and Tax Statement
Copy I -For VI Bwenu of Internal Revenue or Copy IS-For Employer
FTC0005
Dapartment of toe Treedury—Intermit Nuance ScMco
For Privacy Act end Pap/neat Floduatton Act NotIco
and tratruotions, see Form W-359.
EFTA00176016
p cpettal number
22222
Void
OMB Na. 1145.0008
b Employer Idantlfeetion number ON)
66-0567418
1 WWI, ape, other oomponxtlIon
22766.01
2 VI Income tax withhold
2108.00
o Employer's name, address, and ZIP cods
6100 RED HOOK QUARTER 8-3
ST. THOMAS
. 00802
3 Social Bawdy wages
24063.91
4 Scelal security 1w wkhhokl
1491.96
5 Mettlexo wngeletrbilgb . 91 6 Medicare Nut with348.93
7 Social sevolly OS
aY
p0••
1
123 Soo Form lAh.3.55 Inshvolons
S
1297.84
d Employee's social security number
580-29-3823
9 Advance EIC payment
,
a ErIMOTfirriitAltrrno end Initial
Last name
Suff.
PO BOX 306077
ST. THOMAS, VI, 00803
f 5m
eels address and tpc o
11 Nonavollad lane
13 re
'Z, " Mr
120
•
14 Other
12c
174
0
4
/
/
rnrm litl-2111
U.S. Virgin Islands
Warle and Tax Statement
2006
Department of I • Tremerry—Internot
etInn
Revenue Witco
Far PiruaAv Att a nd Prmannark Rnelu
Ant Moth-A
Copy I .For VI Eitrreeti e internal Revenue or Copy l)-For Employer
A Control number
22222
b Empieyw Identtaelca number (FINS
66-0567418
and Instructions, see Ferri W.35.9.
OMB No. 1645.0008
1 Wagoo, ese, other compenseton
45986.1C
3 Soolol accurity wags*
47613.9S
2 VI Income tax withhold
1657.00
a Worm% name, Same, and LP code
6100 RED HOOK QUARTER 8-3
ST. THOMAS
, 00802
d Empoyee'n soca mmulty numb
580 —11 —2957,'
• RmPlOyoo• trot name and Mel
Out home
UNA R
PASCAL
HIDDEN VALLEY BLDG. 13 APT. 239
ST. THOMAS, VI, 00802
Advance 90 payment
I
imeo addrota and 2IP code
Form
U.S. Virgin Islands
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy D-For Employer
Sun, 11 Nonqualiked pans
W-2111
2006
4 Sottol security tax withhold
2952.07
6 thedlootolax withheld
690.40
la Soo Farm W.OSS instructions
1 S
11627.89
2b C 140.82
old
Department of the Tressuni—triternai Revenue Servion
Por PrIvooy Act And Paperwork RoduatIon Act Notice
and mstruotionS, see Ponti W-0$$.
PUNE
EFTA00176017
a ContrdnuMber
•
42222
Void
OMB No.1545.0005 '
b Employer !dont160110,1 IIUMW (ON)
66-0567418
Employes name, address, and 23P code
6100 RED HOOTER
B-3
ST. THOMAS
, 00802
d Employee's social larcurily number
066-64-1041
a Employee's first name sod
Lest name
ANN M
RODRIGUEZ
6014 ESTATE SMITHBAY
ST. • THOMAS , VI 00802
1 IARSIR7. tip, Otter oompertation
32443.4-,
3 Scala Security W0543
33689.3E
I Elmolovoo's address and ZIP coda
Suff.
Fenn
Copy 1-For VI Bureau of 'Memo! Revenue or Copy D-For Employer
U,S. Virgin Islands
Wage and Tax Statement
2 VI income lax vallihsId
203.00
6 Medicare wagesa-3
and -erg. 3C
7 Social warily tips
0 Advance SIC payment
11 Nonquatted plans
4 Seal security tax wIthheld
2088.74
7 1/ //
Far
TM?
%teem
2006
14 Other
12o
7.15
1
Depertmant of the TI•wsunh—Intomol Revenue 5m4ofo
For Privacy Act end Paperwork Reduction Act Notice
and instnalione, see Form W-33S.
e Control number
22222
Vold 0
OMB No. 15413-0000
b Employer identlfiestion number (FIN)
66-0567418
1 Ways, tPa, other ramp ensellon
40174.72
2 1.4 Income tax withheld
3502.00
Employer's nen%
and ZIP cede
I
COMPANY, INC.
QUARTER B-3
, 00802
3 Sookfd security wages
43275.92
4 Social aecuitty tax withheld
2683.11
a
address,
FINANCIAL TRUST
6100 RED HOOK
ST. THOMAS
5 Medicate worm and Ups
43275.92
6 Metheve tax %OMEN
627.50
7 Social tecurItY II0e
a r
d amployoces social eocurtty number
580-15-5038
9 Advance EIO payment
10
rd/
a Employee's brat name and WIN
Leg name
Suf.
JERMAINE A
RUAN
UVI FAC, E. APT.1 BLDG. 3.
ST. THOMAS, VI, 00604
t Em to Ms address
ZIP tad
11 Nonpuoktexl plena
12a See Form
InetructIons
I S 13 1.20
13 th.IA.1/414
Wiwi
P4Vprr
n
61 Li
11)
=2C
128.34
14 Other
12e
1
I
fl u
W2V1 U.S. Virgin Islands
Fenn
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy 0 -For Employer
FTC0007
2006
Copsrtmont of the Trentury—knemai Novenae fiervlco
For Privacy Act and Paperwork Reduction Aot Notice
and Instructions, see Form W-395.
EFTA00176018
F H;72
voct
h Employer IdentifIcatbn number yam
66-0567418
o Entheayera nerne, addr0314 and ZIP ooda
FINANCIAL
TRUST COMPANY,
INC.
6100 RED HOOK QUARTER -3
ST. THOMAS
a
00802
o EnDiTgi gritivgt mire era oral
UQ.O.
P.O. BOX 11184
ST. THOMAS,
USVI, 00801
Employ/We satire.* and ZIP coda
to
LACE
DIAS No. 1545.0000
sun.
W-2V1
Form
Copy 1-P9r VI Bureau of Internal Revenue or Copy D-For Employer
z
U.S, Virgin islands
Wage and Tax Statement
1 Wages, bps, other cempcncal/rni
41567.9
11 Nencluallfied plane
13 tether
gram
e
14 Othcr
2 VI Income trot wIllthe'd
4448.00
Soda' security tax Withheld
4
2857.17
0 Medicare tax wIthlteld
668.21
rasa'
re'
'33.61
2006
124
Department of the Treasury—Intern* liovenua Service
For Privacy Act anti Paperwork Reduction Act Notice
and Instructions, see Form W-355.
a Control number
22222
\led 0
CMS No. 1645-0009
b Employer Identificadon number [SIN)
1 %Ka tips, Cher centheneetIon
2 VI Income tax wAhheld
a Employers name, address, the ZIP coda
3 Social smutty wages
Social aarnally tax witNield
0 htedlorne Wages and tips
T Sethi security lips
d Emozoyee's soda sootsrity number
e Employee's Est name and Initial
Last nem*
E
10 Ito • dace and ZIP code
Form W-2111
2006
U.S, Virgin islands
Wage and Tax Statement
Cot y 1-For VI Sureau of Internal Revenue or Copy 0 -For Employer
Suer.
0 Mocker° tor whithefd
9 Advance SIC payment
10
tU
Nonquallaed plans
12e Sae Form W-059 In:krone
13 bytz
n
14 other
I
creu
k tarr
Alb
I '1
Ilp
12°
12d
bcpattmant of the Treasury—internal Revenue Service
For Privacy Act and Popov/ark Reduction Act Notice
and Instruction, coo Form W-39S.
FTC0008
EFTA00176019
Ccotrot numb,:
33333
For Official Use Only P.
OMB No. terts.muta
b
edl.SS
Military
241
Kind
K
Mili
0
1 Woos, bps, olher oompansetbn
717905.56
2 Income TeX withheld
116884.00
of
Habrd
r.illadloare
Thed•porty
Payer
on
owl. amp,
Oleic
9 Sostel security wages
593493.31
4 SOOlal esouttry tax Withheld
36175.97
0 Told nurnber ol Forms W-2
1
d Ealeheshment number
S 'indooro wages and lido
751782.06
0 Moticaro toot vAl Meld
10900.85
.9
ci Employer Nonage/won numbafEIN)
66-0567418
7 Soared security lips
f
f Employers name
FINANCIAL TRUST COMPANYt INC.
9 AthronO8 EIC (my/vents
fo
6100 RED HOOK QUARTER B-3
I
11 Nonquasited plane
"
Deferred compensation
33876.50
ST. THOMAS
.I, 00802
13 For thmdeany sick paY use only
g Employers excess sod ZIP coda
14 Income lax withheld by payer of thIrd.pnny stok pay
h Orlwr BIN used Ns year
7/
I Employers %Hertel ID numitor
Contact person
JEANDTP _B.RENNAN
Tdophone number
(no ) 7_7_6-2P525
For Orectei Use Only
E-rnail oddity's
Fax number
(340)775-.2528
Under penollle3 01 PadulY. I do
they aro true correct, and
Signature *
hay
figned Ihle return
Co
au
1—Forocom Loic%;r:ccx.Deeptearndejlotthe best
of
my itbssmastss and bow,
Q.Assbari r
Delo tr. 44/04
FormW-3SS
Transmittal of Wage and Tax Statements 2 00 5
General Instructions for Forms W-2AS,
W4GU, W-2011.4, and W-2VI
Furnishing Copies la end 0 to employees. Furnish Copies B and G of
Ferree WEAS, W.2GU, MOM, and WWI to your employees by
January 31, 2006. If employment ends before December 31, 2005, you may
furnish the copies any time allot employment enter but no later then
January 31. 2008. If the employee asks for the form, furnish him or her tho
completed copies within ao days of tho rawest or within 30 days of the
last wage payment, whichever le later. If an employee loses a form, writo
'REISSUED STATEMENT' on the now copy (uNeos It was furnished
otoclronloally), but do not send Copy A of thuolpoyeaThg@SMIgo the
SSA. Employers are not prohibited (by the Intoth5IREWARESVIWME. No. 2
charging a tee for the issuanoirnf a dupUeate Form WEAS, W-2GU,
W.2CM, or MUT.
Extension to furnish Forms W4 to employeers Yoflag Fiat gt 05
extension of time to provide Forms WE to ample
by sending a lot r
IRS Enterprise Computing artratRIOn6VtalltE ST. THOMAS
Information Reporting program
Attn: Extension of Time Coordinator
240 Murall Drive
Keameyeville, WV 25430
Mae your letter on or before the due Pete for fumIshIng Forms WE to
employees, It must Include:
• Yam name and address,
• Your employer Identiecellen number (EIN),
• A statornemt that you aro roqueolIng en extension to furnish Forms WI
to omplay003,
• Racoon for delay, and
• Your signature or that of your authodied ngent.
cowmen or tho Treasury
Warn& Swamp Seeks
UndelNeeeble toms. Keep for 4 years any employee copies of Forms
W-2AS, W-20V, WECM, or W-2VI that yov tiled to deriver but could not.
Do not send undeliverable forms to the GSA,
Calendar year basin. Base a1 Ontries on Fame W4AS, W.2GU, W-2CM,
*EA, and W-3SS on a calendar year. Use the currant year total.
Negneto medlareloctronlc ripening. If you Illo 250 or more Forme
W-20U, Wi2CM, or WEW, you must Vie them on magnetic media
or eleohontoally. You Can got spadrcations for ling thls Information on
magnetic media or oloctronically by visiting Sodal Socurity's Employer
Reporting Instructione and Information websIte at
InvicgoOlessouril$110y/employer or by contacting an SSA Employer
Services MUM Officer (ESLO) at 7874864.574 lot the U.S. Virgin islands
or S10-970-8247 for Guam and ArnartconRemoa. SSA will not accept
magnetic tape and cartridge submissions beginning Wth the 2005 Form
W-2 ropons that are duo to SSA In calendar year 2005.
If you III& on magneto 'Wallet or ofeatronlcally, do not We the came
returns on paper.
Moto: You are encouraged to file on magneto diskette or electronkeily
Vbven If ycv file fewer than 260 Forme W4.
You may request a waiver on Fenn 8508, Request for Waiver From Fling
Information Returns Magneticsay. Submit Form 0508 to the IRS at least 45
days before the duo dale of Form W4, See Form 6508 for filing
Information.
Taxpayer Identification numbers. Employers use an employer
Identification number (EIN) (00.0000000). Employees Use a nodal security
number (S9N) (000.00-0000): When you list a number, separato rho nine
digits properly to show tho kind of number.
Social saounly numbers are used to record employee °ambles for Mute
social erronty end Medicare tionolite. You must show the correct *Add
security number In box d on tho Form W-2A6, WEGU, or MY!.
Page 3
FTC0009
EFTA00176020
o Oontrol numbor
2222E
Vold
OMB No. toasome
b Employer identification number (EIN)
66-0567418
o 'Employer's name. address, and ZIP code
6100 RED HOOK QUARTER 8-3
ST. THOMAS
, 00902
d Employee's social murky renter
580-06-2353
aatr i"mrslad
IVRIAN GORDON
13215 WHITE MOON COURT
CHARLOTTE, NC 28213
f Emobvee's address and ZIP code
Form
Copy 1-For Ol Bureau of Internal Revenue or Copy O-For Employer
VII-2111
WePes. tiPA other rempehsatIon
35487.81
3 Social security wawa
39426.92
hiergoora tirleml les 92
9 Advance EIO paymoro.
11 Nonouelified plane
13 M ay
re
;W ir
t
MY
n
14 Other
2 VI Income tax withheld
3837.00
4 Sochi' moudly lax wlthhald
2444.47
5 Medicare tax Thad
■
71.69
ib 8.o riV4SSi ligructio‘D
12o
12d
3
15.82
U.S. Virgin Islands
Wage and Tax Statement
2005
Einporencht of the Treasury—Interpol Retinue &Moo
kr Privacy Act end Paperwork Reduction Aot Notice
and InotmotIons, see Form W-359.
a Control number
27222`
Vold O
OMB No. 1545-0000
b Employer Idontelcatton number IEIN)
66-0567418
1 Wages. Ilea other ororipenatron
85718.27
2 VI Income tax withheld
8549.00
o Employers name. address, and ZIP code
6100 RED HOOK QUARTER 8-3
ST. THOMAS
, 00802
3 &did acculi olOso .00
4 Social secudly lex wIthlicd
5580.00
5 Medkaro wages end tos
91180.46
6 wain'. taxnod
2.12
7 Social °acuity tips
4
41 Employee" sods' mouthy number
150-46-4746
9 Advance GIC payment
V
A
• BM:401rodr. Bat name and Mal
JEANNE
6501 RED HOOK PLAZA STE.
FMB 201
ST. THOMAS, VI, 00802
'
e DTI
no.* ectctrese and zit -••e
11 Nelltrungltod plans
12d See Form noes Im mo:done
5462.19
13iga zr
mr
"Cl
45.04
14 Otter
i
24
12d
i. r
/
rorm
U.S.VirenIMande
VOigeandTexStatemmft
Copy 1-For VI Bureau of Internal Revenue or Copy D.For Employer 2005
Deportment of the 1roasury—Interncl Finance Service
For Privacy Act and Paperwork Reduction Aot Notice
and Instructions, sea Fawn Vti3SS.
FTC0010
EFTA00176021
a Cannel number
I
E
7
v
o
w
l
E
l
l
oars No.1649.0008
b Employee IdontIlkallon number (Ellia
66-056/418
o Ornpitmere roMe. sdatuto, end ZIP code
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.V.I, 00802
1 Wept, fps, other oempotealbn
43574.16
2 VI Income Lax v4thhold
4806.00
Scala] so:tfty Wean
48390.99
5 Medicare wpm 39
O
and Hoe
48
.99
I
Social zreeunty Ups
d Wept/yen socks murky number
580-03.9952
e Employee's lint nerve end innhe
LEON A
P.O. BOX 503032
ST. THOMAS, VI, 00805
0 Advance MC payment
f Em la eohr addrobe end ZIP coda
W-2111
Form
Last name
CASEY, SR.
200.5
U.S. Virgin Islands
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy b•For Employer
11 Nonquallfled DIMS
Social mourtry Mx withheld
000.24
12a See Form W-3SS Instivonoml
p
4816.83
13 Inen latt
tik,/
Una."
14 Other
rb
22.21
Deportment of the Treesury--Imernol Revenue Smiler.
Fee priveoy Act and Pepenvork IledUctIon Act Notice
and Instructions. Mte Form WASS.
a Control number
22222
old
b Employer identifiedlon number CON)
66-0567418
o Employoesmmteddienandwicode
6100 RED HOOK QUARTER B-3
ST. THOMAS
.1, 00802
d Employee's metal Con* numbs,
580-13-4697
EmPlOY0010 fat came end Inhlai
Lad name
JAMIE I
CORNELIUS
6501 RED HOOK PLAZA
EMS 201
ST. THOMAS, VI, 00802
Form
detron end 23P coda
111,-2V1
U.S. Virgin Islands
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy D.For Employer
OMB No. 1045.000a
1 Wages, tko, omar compensallOn
41913.27
3 Social secretly wage*
4 Scold security tax wIthheld
44630.48
2767.09
2 VI into= tax wIthlield
5754.00'
9 Advenoc FIC Payment
11 Nonquerrfled plena
2005
0 Medleere tax wthheld
647.14
2e Sao Form W-333 Instruellery
4717.21
18.10
120
I
12d
'4
Deponorr.At of the Troaeury—Inlernal Revenue Service
For Privacy Act and PeperWork Roductlan Act Notice
and InstmetIons, coo Form 9/-aSS.
FTCO011
EFTA00176022
a Orntml number
22222
Vold
OMB No. 1545-0008
b Employer identification number (EIN)
66-0567418
c Employees name, address, and ZIP code
6100 RED ROOK QUARTER 8-3
ST. THOMAS
, 00802
1 Wages, tip, other oompanarillon
99216.23
3 Social sOtUrt4
8 VI Income tax wthhold
18661.00
4 Social etnarlty
5580Nix withheld
0
.0
5 Netnews nog and lies
96.99
Medico. taxivrsid
8.41
7 gerbil sonority tIps
d Employee's sociN security nvmbsr
580-06-1538
9 Advance BC payment
a employee*, lint name and mom
CECILE R
P.O. Box. 8361
ST. THOMAS, VI, 00801
0....7,1nuarti• 7APIran• AAA 710 inw.7.
tact Mme
DE oNos
11 NonqusIlled pions
14 Othnr
10
i
Form VI-2111
Virgin
Ta
Islands
Wage and
x statement
Copy 1-For VI Bureau of Internal Revenue or Copy El-For Employer 2005
Department of the lIcesery—intemel Revenue Service
For Privacy Act end Paperwork RoskrcUon Ant Notice
end asstmoilonv, coo Fenn W-339
20
Ed
a Control number
22222
Void
WO No. 1515.0008
b Employer Idanaloattan number ION)
66-0567418
O Employees name, ockheaa, and 21P oode
6100 RED HOOK QUARTER 8-3
ST. THOMAS
f 00802
1 Wagon, tbe,othor earrporeolon
241021.30
3 Social aecurlt•it wages
90000.00
2 VI Incorno tax withheld
65631.00
4 Social away Itoc wit held
5580.00
o Medicare %kiln
81
"'an M 0221. 30
7 eosin] *murky tips
d employes social eeeVky number
090-4448a48
• Employee's first nom, end SSW
IAN memo
JEFFREY E
• EPSTEIN
9 Advance EIO payment
•• • •
6100 RED HOOK, SUITE 2
ST. THOMAS, VI, 00802
/Sara%
Z
I U.S. Virgin Islands
Form VW
Wage and Tax Statement
Copy 1-For VI Burenu of Internal Revenue cr Copy O-For Employe: 2005
11 Nonquebliod plena
13 Savo",
I
*AI
14 Other
Rs $ee Form W-33$ I
021.28nstruction
is
2d
Dopartmost of the Treesury—leternitl Reverses Service
Pear Privacy Act end Paperwork Reduction Act Malice
and Instructioho, SOO Form W-SSS.
FTCOM
EFTA00176023
Conant number
22222
i void
b Employer WentMoron number (EIN)
66-0567418
OMB No. 1545.0008
Empbpre name. address. and VP *ado
6100 RED HO2EMETER B-3
ST. THOMAS IIIIIII, 00802
1 Wages, Opt, 01lla oomparridon
650.00
3 Social security were
650.00
2 Vi I-worm MX withheld
68.00
4 Social vecodty tax withhold
40.30
d Empkyereo soolel co0uty nuntor
580-23-1452
Ihriployaole list nem and InICal
UM name
TEQUASI 0
HENDRICKS
PO BOX 672
ST. JOHN, USVI, 00831
f emninveree %Arleen and 235 node
Form W-2111
U.S. Virgin islands
Wage and Tax Statement
Copy 1-For VI Burnt! Of Interne] Revenue or 0opy D-For Employer
7 Social snoUrity tips
9 Advance SO payment
14 Other
2n Soo Form W-386 liwtruorcort
2005
Department of tho Tomeury—MIOMN Rovonut SotVICP
For Privacy Act and Paperwork Reduction Act Notice
and instructions, coo Form W-055.
a Control numbot
22222.
Vold O
OMB No.1846.00045
b employs/ Identilicedion number (EIN)
66-0567418
1 WNW/. Os, other comic:wooden
21670.14
2 VI income lax withhold
1815.00
c Employers nom addisee, and ZIP coda
6100 RED HOOKQUARTER B-3
ST. THOMAS
, 00802
3 Social security virrgell
22396.74
o Soda' seconty tax yAthheld
1388.60
6 Wean) wage; credit o
22396.74
0 Medlar tax withheld
324.75
7 Sociat MAW tips
10
/
d Erripewaolo Coalal acidity number
580-29-3823
9 Advance EC payment
e ErNioyoe`e first name and tend
Last name
LORETTA
PO BOX 306077
ST. THOMAS, VI, 00803
1 Ern lo co's addrori and ZIP code
it NonquallOod piers
12e See Penn W498 inetructionS
p
126.60
13 er03%
it ilrICIOt
War
WI
El
la
I
14 Other
770 i i
12d
A
inic2iin U.S. Virgin Islands
Form
Wage and Tex Statement
2005
Department of the Troacury—inlemel Revenue Service
Por Of}igiev Ant and Pennaaatde !forlorn... An tln..n•
Copy 1-For VI Bureau of Internal Revenue or Copy b•For Employer
FTC0013
end Inatnlelkns, ace Form W- SS.
EFTA00176024
a Control number
22222
Void
ONO No. 15460000
b Etrployot IdenFandon number Eim
66-0567418
o Employers name, address, and ZIP cods
6100 RED HOOK QUARTER B -3
ST. THOMAS
r 00802
1 Woos, lip., other compentibn
41893.44
3 $octal county wages
43126.06
a Employee's social sorority number
580-11-2937
o enayor ant name end mai
taitt2inhrziAL
HIDDEN VALLEY BLDG. 13 APT. 239
CHARLOTTE AMALIE, VI, 00802
t Employee's address ad Zip code
Form
Copy 1-For VI Bureau of Internet Revenue or Copy D-For Employer
W-2V1
U.S. Virgin Islands
Wage and Tax Statement
'''''"1".3rir. 06
2 VI Inseam tax withhold
1052.00
4 Sonl moray lax wIthhdd
2673.82
7 Sacral smithy tips
9 Advance EIC payment
tt Nonquallflod plans
3
14 Other
2005
10
6 Medic/ire tax withheld
62-5.33
2a Soo Forniit.369.Istruetion
y2:32.6
r
57.32
2c
r
Department of the Treasity—internel Revenue SsMct
For Penney Act end PapOlwor1t Reduction Act Notice
and Instructions, coo Form Vn3SS.
o Control nurnbor
22222
void
OMB No. 1646-0006
a Employer Pannonian number (SIN)
66-0567418
1 Wa$, IIPS other compematipi
29819.87
2 VI Income tax wIthheld
4.00
o Employer's name, address, and ZIP ono
6100 RED HOOK QUARTER B-3
ST. THOMAS
f 00802
9 Social soxrIW wages
30695.54
4 Sorter security tax rinheid
1903.12
a maakar"Tongt54
ti MoOletra lex withhtid
445.09
7 Soarer security Ups
6,
d Employee's social security number
066-64-1041
..
....
a Memo° EIC payment
10
a Epp larine Pet norm and Inn
last name
ANN M
RODRIGUEZ
6014 ESTATE SMITHBAY
ST. THOMAS, VI 00802
I E
's address nd IP
11* Nonqualleod plans
12
Emi lie-39S herniation
p
1
a Seo 75.67
Is rz}.7. „„.,..
„,,
,
0
1.03
„ r
14 Other
Fa
I
Farm i~ - ~YII
U.S. Virgin Islands
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy D•For Employer 2005
Department of the Treasury—infernal Ronne° Son1ce
For Privacy Aot and Paperwork Reduction Act Bother
end Instruction', See Form W495.
FTC0014
EFTA00176025
a control number
k_._--..
•
22222 LVed
OMB No. 1545.0005
b Employer Identification number (£IM
66-0567418
1 VAlget, toe, other cortpeceedon
38196.15
2 Vi Income tax vdtbheld
3250.00
o Employees none, address, end 2IP code
3 Scold security wages
41069.29
d $ocel smutty sae withheld
2546.30
6100 RED HOOK QUARTER B-3
ST. THOMAS
00802
5 Medicare me . and
29
6
cora tax wahheal
595.50
.1,
7 Social security Ups
6
d Employelea imolai staidly number
580-15-5038
9 Advance BO payment
10
a Employee's list mato and Iasi
last norm
.CERMAINE A
RUAN
11 Nomma.nad pine
1R0 B4O FO
NIBS InStrUCtial0
3873.14
UVI FAC. E. APT.1 BLDG. 3.
ST.. TBOOAS, VId •00804
la WI%
lA ihn
lo
w
r i
4_,
14.03
r
14 Other
j20
fi
1
I
$ and 21P code
Kam. IN-2111
ILS. Virgin Islands
Wade angd Tax Statement
200.5
Act nd
ForaDpartment of the Tr
Po
odstny—..ntemOt Revenue Senhco
Privacy
ectwork Reduction Acrt Notice
Copy 1-For VI Bureau of Intornel Revenue or Copy D-For EmplOyor
and In-clime:dons, sari Form NOSS
(1 controlnumber
22222
O.
No. 1545.0009
Vold •
D Employer IdondlIcatIon number (SIM
660567418
1 Wage; 11pc,, am COMpf24:4011
38744.92
2 VI Income ta4 width cid
3757.00
o Employees name, Wrote, and EP coda
6100 RED HOOK QUARTER B-3
ST. THOMAS
, 00802
3 Soolol Socudty wages
43097.29
4 Social amity tax Sifted
2672.03
ages
6 Meellearo w
and Cps
43097.29
0 Median tax whhhotI
624.91
7 Sacral pocu4ty tras
yr
y..„
d Employer's social security number
580-17-3729
0 Advance EIO moron'
10
a employee's lint narrn and Iraqi
Last name
DAPHNE L
WALLACE
P.O. BOX 11184
ST. THOMAS, USVI, 00801
f Rm
co'; add sea end ZIP coda
11 Normusliflod piona
2a See Form W489 Inelructiona
4352.37
is sot
h
fa
Trgr
r)
ri
12b
F
4'0.29
14 Other
IR°
1
12d
/
4
Kern W-2111 u.s. virgin islands
Wage and Tax Statement
Copy 1-For VI Bureau of Internal Revenue or Copy D-For Employer 2005
Dapergrsont of the 7renoury—Intomml gavcours Seneca
For Privacy Act and Ptporviork Reduction Act Node.
end InStruc rt'ona, sec Form 16-36S.
FTC0015
EFTA00176026
2iNOT STAPLE OP FOLD
•
carded (Sabot'
•
•
33313
For Official Ues Only P
OMB No. 13450008
b
S41.8a
Mallory
940
Kind
O
O
•
1 Want ION Mitt copettgallim
732788.1)9
2 •Inoomo tak vilthheld
1.-1.3.3.6.CtaD
or
Mad.
Medicare
7119d•party
O
b
Payer
75
. govH„,p, oar
3 aodal ',multi wages
_6_00411 46
4 Sochi security as withhe'd
17925
An
e Total number of Forms W-2
1 9
d netakashment rester
5 Marlowe wages and tips
7_638.011-0.4
5 Mediate trot withheld
s Employer Idente
tlon number
66-0
ca
8141,8
7 Sochi semsity tips
0
/
/1 A
I (Implant's name
INC,
9 Admen 91C payee:min
0 r
/
/ 1/. /4
-EINANCIA.1....TRUST..COMPANY., •
.
11 NonquaMed plans
12 Dottrrod comps/imam
lq.0_19—.9.5
6100 RBA HOOK QUARTER B-3
ST.THOMAS, usVI
00802
12 For thirdparty sick pay use arty
'
cr Employer° address and ZP oaf,
14 Income tax whrilidd by payer of third-party dot pay
h Othir EIN used sae year
16 Oheck the eppropriete bas
Typo k
W-2A$
W-2Cal
W-2OU
W-2Vl
I
Employer's tonitoriel ID numb&
Fonn jr
0
si
0
us
zr
Contact person
.1•0.11110.—Ba.
Telephone number
2526
For 6fliciri Use Only
Ihrnit addrixis
LI
--/-3.4.0 1 -775
Fox number
( 3,0
) 7-75
Copy A—For Social Security Administration
Uncles penalties of Polon/. I declare that I have examined tits !Own and accompanyhg documents, end, to the bast of my knowledge red beef,
try are t
• coned, and complete.
gnome r.
Me I- deas
idac
Date e•
2.4510
%
'ire WI" SS
li•ansmittal of Wage and Tax. Statements
2004
end this entire page with tho claim Copy A page of Forms W-2AS, W-2AU, W-20M, or W-2V1
) tho Social Security Administration (SSA). Photocoplos are not acceptable.
o not send any remittance (cash, oheaks,4 nay orders, eto.) with Forms W-2AS, W-2GU, W-20M, W-2VI, and W-2.95.
Istruotions for Forms W-2AS, W-2GU, W 44,7
However, If you lie elootronlyely, you may file by Meroh 31, 2005. Soc the SSA
nd W-38S
s/t,re
webelto et www.eoei■lsecwlty.gov/employer/for oladronlo dna optic:co.
reffon fakirs:meta me to the intern& Revenue Codo (Mises oihcerggnotfir4
1 W.2cht, or W-2Vl by Denting Form 8809, Application for Extonolon of
/1O4,Extenslon to Me. You may request en extmelon of time to file Forms W-2AS,
1/14,
/SY
c
p ,
TbVb To File information Retune, to the address shown on that form. You must
request the extenelon by the die date at the forms for your request to be
ems To Note
4,4m00
ew nice for 2004 Forms W-2A8, W-2AU, W.2VI, and W
arms
considered. You will have an additional 30 days to Ito. See Form 8900 for
-2AS, W•20U, VV.2VI. end W358 wore relormetted to earforrn
id margins used In the subeiltne black end whho loser Forme W-2 en
144,4).
UOp Caution: Even If you reoefre hextenAton of tkno to ate panne W-2AS, W.20(1,
'own In Exhibits; E and F of the May 2003 revision of Pub. 1141, Eltriem) HuMetaf,vats,
W-2014, or W-21.4, you must Oa fumfsh the forms to your =No)om by January
id Specifications for Sabo:Hum Forms W•2 end W4, This things stows
P181, 2005. But coo Extonaton to furnish Forms (V.2 to employees on Pita 3.
°grammars to mite untested oode for date entry on both the ottidol and the
tor-printed versions of the forme. Make cortnin that Copy A of your paper
wins W-2AS, W-QU, W.2VI, and W$SS reflects these changes,
strove! of dollar signs and shading. The dollar ergno mid shading have been
moved from Copy A of Forme W.2AS.W•261U, W4VI, and W-33-5 to provide
aro Motto Do not chow dollar sign pr) when reporting monsy amounts
sw reporting code for box 12. A new code (Code W—Ernployer's contribution
on anithioyoceo Health Savings Account) has been addod for use In box 12 of
Pne W-2AS, W-260, end W.2VI. See pegs S for &Axis.
then To File
e Copy .A of Form W-338 Wan Copy A of Form W.2AS, W.2CIU,W-2CM, or
.2VI (including roporte nod on magnetic modify by February 28, 2005.
Oesivanter or tes Tanury
mams{ 6rvenve (service
Whore To File Copy A
Sand the eats Bret pogo of this form (Copy P) whh the entire Copy A page of
Porn W-2AS,
W-2CM. or W-2VI to:
Sooty' Security AdmInlatreflon
Data Operations Center
Wilkes-Bane, PA 18709.9001
Note: If you arse -CortiEed Mell" to hie, Menge the ZIP code to "18769-0002.' If
you use en if7Pappmvod penile donvery service, aid -A77N: 1442 Process,
tt60 E. MoUntorn Dr." to the address end change the ZP code to -16V02-7597.°
See Ofroulor (Pub. 16), Employe,. Tat Outdo, fore let of IRSnrproved
prNeto dotNay services.
Also Deo Whore to no Copy 1 and Shipping and rnttling on pope 2.
FTC0016
Cot, No. 101176
EFTA00176027
e Control ~bar
Vok
OMIS
EmEloYerldenhfOollon numbsr
66-0567418
1 Mao, ilps, olhere3ingsnagell
59341.18
2VIlmomobswM1158
6418.00
4 Soda; sacrudly trderilted
82.15
• Empioyol'a neme, aderen, and ZIP code
610O RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
strrlIAN GORDON
3 Settel ;welk
os.
4
6m
.18
5 Mitdloara waggtg tt5.18
41
Modicoto taxwIthheW
964.70
7 Soda' securlly tips
41
9 AdvanoaElCpoymonl
tiltje
PM neme wedMIMI
P.O.
BOH..115
ST. THOMAS, . VI, O0804
I E •to 0øo ruldrosu and ZIP coda
a Control mater
b Employorldeulficatlon number
66—e 67418
o Employsts name, inham, and ZIP cal
6100 RED HOOK QUARTER 8-3
ST. THOMAS U.S.VIRGIN , 00802
d Employee% BOUW Securky mimiset'
150-46-4746
c Employees Arst name and
inst neme
JEANNE
6501 RED HOOK PLAZA STE.
?ms 201
ST. THOMAS, VI, 00802
11 Nonclualled plans
13 mat
.
14 Mar
Employees addrols eed ZAP code
Itea
PlorgigVd38896.riona
91.22
12c
2
12d
k
U.S. VirgPn3slands
FormIN-211m w.g.:* and Tax Statement
Copy D - Fer Erncloyur
200
Dopertmant of Ina fressury -'mama( Revenu., Eersile
For Privacy Act and Paporwork Roduotion Act NoUo
and InstrucUonc. sec FOfill
1 Watts, Wo, ahor cowpomatco
a
3 soolal socurkympts1 7 11
87137.22
2 VI lnoorno hanyrUshold
8022.00
4 Soda] escurIty tas wilhhold
5402.51
5 blacilmat wist end Ups
6 Wekere las witheid
87137.22
1263.49
11 nonavolfiod plana
14 Other
12.1 Sue Farm WaSS Inatnn6ons
S 15220.11
12e
12d
[137.25
W m nag
U.S.VinVnID95and9
Vorm bitl
5.(ss t8
WeIge and Tatt Statement
Copy D • For Er ploydr
200
Deportmant of Mc Traesury Irdernal Royanuo Setvl
For Privacy Aot and Paparwork Reduotion Aol Non
and Instrumiona, sec Form W45.
FTCUOI7
EFTA00176028
a Contnn number
IT
b Employer ideancetion number
66-0567418
Vold
▪ EmptoyereDanyk Oddlara, and ZIP code
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
O108 No.1646-0008
d Employ0011 toad vacuity number
580-03-9952
• LINO
naMO 0.10 toad
P.O. BOX 503032
ST. THOMAS, VI, 00805
f Emulovorre oddront and ZIP code
'Mix, SR.
rom,W-2Vi U.S. WM, Islands
Wage and Tax Statement
Copy D - For Employee
a Control number
b Employer Identification number
66-0567418
Vold
wqmocommtmalimm
42312.73
2 Vi Immo lax withheld
4328.00
4 Boded security tp6 wIthbeld
2913.42
3 Social oecurayeesbarb
0.63
Medicare water
919.63
6 kiedleara lex ..thigg
7 Social security Oa
9 Advance RIC payment
11 NenounflOod plane
13
twr
RmMnn,t nw
II
I
•
14 Other
2004
1.36
10
it
Soo FloTerTIS Tboctions
120,
211.63
12o
12d
Department of the Treostny - Internal Revenue Sow
For Privacy Act and Paperwork Reduction Act Not i
and IntdrU011on5, Sao Farm W-3:
OMB No. 1646400.9
o Employees mi., address, and ZIP cod
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
d Employee's social beady iwmbor
580-13-4697
a aapiaroallnd name and Inicei
Lest name
JAMIE I
CORNELIUS
6501 RED HOOK PLAZA
PMB 201
ST. THOMAS, VI, 00802
1 mvakcomomonom
47313.38
3 sp*Isemaitymmes
51249.78
Erre:ors:a oddity] Mid ZIP code
Copy D • For Employer
Medicare wagesend4e
51249.78
7 Sodal security 44
utfing U.S. Virgin Islands
Form UM
Wage and Tax Statement
2004
DOPertment of to Treasury - Internal Revenue Servlo
For Privacy Aot and Paperwork Reduction Act Natter
and InstructIone, tee Poem 1.4-33:
9 AchninO0 CC paymcµ
14 Other
2 V1 Intorno bor vertliekr
6 11.00
4 Sodd Comity tox wdrheld
3177.49
6 1/4dItem lax vAllgield
743.12
12a See Form W.3SS Instructions
! S
j3936.40
12b
:C 144.78
FT[UUI8
EFTA00176029
a Controlnumber
b Employer Identitiesnon number
66-0567418
o Employers93mA address, and ZIP cede
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
Void
0Ma No. I wane
1 Wages. Ups. crissicempemsten
2 VI Income tax wIthhotd
97072.89
13099.00
3 "'"nlbo.00
4 Social murky taktabbsid
5449.80
1
462T/
.80
6 Medicare
ni
8 Medicare tax elIbtahl
1481.51
d Employee% modal unease number
580 - 06- 1538
e RLCtY,aoyfea re, r e
and Inked
P.O. BOX 8361
ST. THOMAS, VI, 00801
f Employee's oddness and ZIP code
Los' oNGH
7 Social amity ape
FormW-2VI u.s. VlagIn Islands
wage and Tax Statement
Copy D For Employer
• Control number
b EmploYor IdrnellIcation number
6-0567418
c Employer's mime, addrsbN end ZIP cod,
3 Soda! sousity weber
87900.00
10
Advanos EIC payment
11 Nonnuratted plan.
12aS Sea Forp31.4389InsEucaons
50 99 .
3
.,2
3
13 .1 tleZ
14 Other
2004
OMB No, 15454009
6100 RED HOOK QUARTER 8-3
ST. THOMAS U.S.VIRGIN , 00802
d Employee's accloi a (+corky number
090-44-3348
o Empeyeee8rat name end WWI
Litt% mime
JEFFREY E
EPSTEIN
6100 RED HOOK, SUITE 2
ST. THOMAS, VI, 00802
'playas's
address and ZIP coda
172.78
12o
12d
Dominant of the Tresaury • internal ROVentle Son4i
For Privacy Act and Paperwork Reduction Act Roth
and Instructions, coo Form W.39
Wagaiklat,ethereemperitaben
241021.28
S Medicare wives end tips
241021.28
7 Social security Ups
9 Advance EIC payment
11 Nonqueallod plans
13
twat
niter
2
income Unt Withheld
65884.00
4 Zoolel security lax withheld
5449.80
6 Medicare tax wtitoH
3494.81
VI7-2VI
U.S. virgin Islands
Form
Weige and Tax Statement
Copy D • For Employer
2004
12a glieFerm W-336 Inertial
C 11021.26
12b
12o
3
12d
Department of the Treasury - Internet Revenue 8ery
For Prlvaoy Aar and Paperwork Reduction Act Noll
•
and Insbeletientl, see Form Welt
FTC0019
EFTA00176030
a Control number
Vold
OMB No.154240009
b employe, idortfleetIon number
66-0567418
o Beciarete nem address. and VPeocle
6100 RED HOOK QUARTER B-3
- ST. THOMAS U.S.VIRGIN , 00802
wsmimawconmilnan
2074.00
2 VI Income lox wilhhald
175.00
4soomwmowmmmici
128.59
d
Empl580-2
oyees
sod3—
el 14
WWI>. number
52
TOVAlmr
IstaDRIOKS
PO BOX 672
ST. JOHN, USVI, 00831
I
employee'', address and ZIP code
-2VI u.s. *nigh) Islands
Perm
Wage and Tax Statement
Copy D - For Employer
3 Social ',curly MVOs
2074.00
S MedlOare wiges and nos
2074.00
7 Social °sootily bps
0 Advance EIC payment
11 NonovotOod phnn
13 :Pt "scam
14 Olhe
6 Median lox wehltolg 0.07
200q
Department of the Treasury - Internal Revenue Serve
For Privacy Act and Paperwork Reduction AS NOW
and instructions, soo Form W-3S
12a Boo Form W.399 Inaauction:
22b
1
12c
a Control number
Veld El
OMB No. 1043-0005
b timpioyor IdonlIticsdon number
66-0567418
1 Vftes, x:re, other compeneallm
21460.81
2 VI Income lox vAthherld
1005.00
. Employee new, address. and 2IP cod ,
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
3 Sedel scour*/ vrepes
22108.99
4 Social eacurtly hnc withhold
1370.76
5 Medicare noon and lips
22108.99
4 Medleore tax withheld
320.58
7 Sochi moodier Iffos
p
d Employer:re social serstSty number
580-29-3823
9 Advent; EIC payment
10
7 .
c Employee's first name and mold
Lost men
Lon TTI
1,
MCDONA1D MORRELL
PO BOX 306077
ST. THOMAS, VI, 00803
I Emproyses addr036 and ZIP o de
11 Nonqueletod plans
120 See Form W•39S 'Idea:dont
I S I 648.18
13 MIZA7
larninann"'
.. " 0
H
14
:
2b
2
I
Other
12a
1
I
12d
1
U.S. VIrgin Islande
gam "
Kg!
Wege and Tax Statement
Copy D • For amplOyer
2004
Department of tho Treasury - Internal Revenue Servl
For Pdvacy Act and Paporwork Reduction Act Not+
and McCue/lone, sae Form W.39
FTC0020
EFTA00176031
a Control amber
vold
OVIB No. 1645.0555
b ellsiersm
74
00nm~
• 6.6•05d6
18
o ancloyn Mg" edden. and Wood*
6100•RED ROOK'QUARTER B-3
ST. THOMAS V.S.VIRGIN , 00602
d ampfoyade »dal nourIty Mester
580-11-2937
e finneoyee'a first moe ard Irdiol
UNA
"MAL
BIDDEN VALLEY BLDG. 13 APT. 239
CHARLOTTE AMALIE, VI, 00802
I Employocio aldrene ond ZIP coda
Copy II -• For Emp:cycr
1 %pek Gpe, othercomposelca
40047.86
3 Sodd tocuely worto
41285.35
2 VI boom° bx vAthhold
1586.00
4 Soclal aeourity lax ~luid
2559.69
B B1O.„...
l•mnewagaffIgpg
7 Soda' stemde/ Opa
9 mvenco Elc payment
11 Non:0009d pleno
14 Other
WOW° DevAthheld
.35
598.64
Perm W-2V, US. VIrgin islands
Wage and fax Statement
200'4
Deportment of Dia Treaaury - Wemel RaYonuo Sereh
Por Privacy Act and Propere/eek Reduction Act Nottc
and Instrucdona, tee Form W49
12o
S
Sec Por
1237
ie W-399 Inote011em
. 49
I
125
12d
1 35.38
n Control neme«
Vold
0615 No. 1545.0003
b Employer IdontlhatIOn amber
66-Q56/418
1 Walles, boa, oteroomponoreol
27935.72
2 VI indom* tag xithheld
9.00
c Iltmployete nam ad dna, and ZIP God,
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
3 Soda' aeourity vage,
28753.16
4 Spelel woedt,/ toe wanheld
1782.70
5 Mede:are wam and Ups
28753.16
5 Molltare tax ~held
416.92
7 Scdal eeg:11y Up
rg
?)// ///2
d Employeeilocielsocunty amber
066-64-1041
9 Advent. EIC ~tont
e Empkoseto Red rom end Mei
I"( name
ANN M
RODRIGUEZ
6014 ESTATE SMITHBAY
ST. THOMAS, VI 00802
t EmpIoyee'o Beton ond ZIP odde
11 Nonquelked plm.
12e Boe Foei, W-365 tratruceono
' S
1817.44
13 myrte
p
incnt Mrt/
12b
IC 13.21
14 Otaer
12a
i
i
1121
!
A
litim29/
U.S.VirginisBands
Form
Vage and Tax Statement
Copy P • For Empl yer
2004
Departnent or 11w TfCB3Uty • interne! Revocuo SON
For Pavocy Aot and Paporteerk RoductIon Act Noll
and I notrudlong, con Fonn W-3!
FTC0021
EFTA00176032
3 Social fettlfily 37
no•OS
983.56
;
.
•
OMB No. 1049.0009
o Empbyete nine, address, and ZIP code
6100 RED HOOK QUARTER B -3
ST. THOMAS U.S.VIRGIN , 00802
d E580-15-5
mployee's eadal 03
eece1ty number
8
e nIffitifiretN nam
E
e end ION
lest name
I
RUAN
UVI FAC. E. APT .1 BLDG. 3.
ST. THOMAS, VI, 00804
f Empbyee't address and ZIP code
Copy P - For Eme%yer
2 VI MOMS tea V.19111010
1 Wages, Ups, elnef cornea/ellen
35326.30
2832.00
4 Goal& emery bystbrd 9,
6 Medicare watejlig
7 SoCiAtsecurtty Ian
3.56
Advance Elepayniont
11 Nonqualltecl plena
14 Other
Formal -2111i U.S. Virgin Islands
wage and Tax Statement
2004
6 Medlcam bervathhelcl
Cb0.76
12a Bee Form IVaSIS Tiros
s
1
12d
'23.00
Department of the Treasury .Internal Revenue ServIcy
Per Privacy pot and Poperwork Reduction Act elotier
and Instructions, see Forth
a Control number
Void
MI
OMB No.1545.0008
b EraplOyerldOntlactillon number
66-0567418
I
V4901. Opt. &her comae:Mika
36964.83
2 VI IncOMO tax urahhokl
3091.00
Emproyert namo, emote, and ZIP cod •
6100 RED HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
3 8aoh•A security wages
41190.09
4 Social enmity tex withheld
2553.79
G ModIcerc wages end Ups
41190.09
6 Medicare lax xithhold
597.26
7 Semi security bps
V
rt
d Irnploy00% extol sweaty number
580-17-3729
9 Advance EIC payment
10 r
A
• ..,,by•,. not roma and WWI
Lest name
DAPHNE L
WALLACE
P.O. BOX 11184
ST. THOMAS, USVI, 00801
f Employee's addcase end ZIP code
11 NoneNellf,od plans
12a See Form W-386 Imeruollort.
S j4225.26
io
i c 129.12
13 'wt. "rm ti
IIIT,; "Y
tl
14 Other
Deportment of the
C •!. 0.1.
AS
12a
i
1
12d
L
Treasury • Internal Revenue ServIt
An
a
n
a
...11
A In
a
,.,„2111
Form Iii
tu,;s; Virgin. v!slelds .......,
2004
Copy!) • For Empkryor
FTG0022
and inatsuctlene, coo Perm W-33;
EFTA00176033
f
ar
STAPLE OR FOLD
b
Central weber
33333 • 1, eor Off Mal Use ontytf
09.18 No.1 asa-ootal
b
041-99
Weary
esa
1 Wan tip; Ober comPanaegon
a Income rox vdthhold
0
0
$ 710836.58
$
16848.0Q__
req. LIS*
~party
a %del secudty wages
4 Social eaeurby tax Wee*
.5
gov
rep.
aloe&
$ 574878.61
$
35642.47
O Total number of Foons ltr.2
d Establishment number
5 Medlcore Wig« and drys
6 Medicare lax withhold •
14
$ 743059.78
$
10774.36
Kind
of
Payer
•
Employer IdenUllowton numbs
6 6-0567 41 8
EmPloYea name
6100 RED HOOX QUARTER 8-3
00802
wmnIl ~Ws nitiman rind 71P coda
ft Other EN used tit year
7 Social Kimsey tpa
$
9
Advance RIO paymonte
11 Nonquoliliod plans
$
19 For thIrdeartY bleb pay uco OW
n
Deferral compenealion
$
12223 ..2.0
A
14 1(1~0 IDX wthhold by payer of third-piny Molt pay
I
Employers Watodal ID number
Contact person
Jeanne Brennan
•
t,
Check the °pawed/de box
Typo k
W-2es
W-203A
>
Form
K
K
K
3
Tatsphana >Nab«
I Por Oilleral Use One/
Fox ~her
(340)775-2528
(340)775-2525
Copy A-For Social Security Administration
Under penalties of perjury, I declare that I have examined this return and e000mperwIng documents, and. to the beet of my knowledge and beset
they are true.
act end complete.
Signature
Perm W-3SS Transmittal of Wage and Tax Statements
2003
Send this entire page with the entire Copy A page of Forms W-2AS, W-2GU, W-2CM, or W-21/I
to the Social Security Administration (SSA). Photocopies are not acceptable,
Do not send any remittance (oash, checks, money orders, etc) with Forms W-2AS, W-2GU, W-2CM, W2VI, and W-358.
Date >
Drawbar:W.01/w ra
Internet Revenues.
IristrucflonsforFonnsVP2AS,W-2GU,M42Vhand
Where To File Copy A
W-3SS
Send the entire first page of this form (Copy A) with the entire Copy A page
Section references ere to the Internal Revenue Code unless othenviyalVED
of Form "AS '
"
CM' or W.2VI
to:
noted.
SE EPTIONIST
Social Security Administration
Data Operations Center
Items to Note
Wilkes-Sarre, PA 10769.0001
Reporting Code Q for box 12.
Recent legislation has elminated the use
When To Ale
twittERIIINGAir nit gi-AENtg UstiTR. T
lid 18702.71207.* see Circular E Employees Tay Guide (Pub. 15)
a et of IRS approved private dolAirtry setVloes. .
File Copy A of Form wass with Copy A of Form w-2AS, %SOU, W-2CM,
Also see Whereto file Copy 1 and Shipping and mailing on page 2,
or W-2VI by March 1, 2004. However, if you file electronically, you may
file by March 31, 2004. See the SSA Web Site at www.aea.gov/employer/
Notice to Employers In the Commonwealth of the Northern
for electronic filitcl optlane.
Marlene Islands
Extension to file, You may request an extension of the to file Forme
If you are en employer In the Commonwealth of the Northern Marlene
~AS, W-20U, W.2•M, or W.2VI by sending Form 9809, Request for
islands; you mutt contact the Division of Revenue end Taxation, Capital
Extension of Time To File Information Returns. to the address shown on
Mn, Saipan, MP 96950, tO get Fonn W-2CM and the Instructions for
that form. You must request the extension by the duo date of the forms for
completing end Wng that form,
your request to be considered. If approved, you will have en additional 30
days tome. See Form arm for more details.
General instructions for Form W-3SS
Caution: Even If you receive an extension of tinto to rile Forms W-2AS,
W-2CM, or W-21/4 you must still furnish the forms to your
employees byFebruary 2, 2004. But see Extension to furnish Forms K2
to employees on page a
FEB 2 4 203itNote: If you use 'Certified Mall' to file, change the ZIP coda to
of Code CI In box 12.
-10769.0002.' Ilya, use an IRS approved private delivery 'entice, add
W2 Prooess 1160 E. Mountain Or to the addreas and change the
Purpose of forms. use Copy A of Fenn MSS to transmit Copy A of
Fenn W.2.AS, W2GU, W-2CM, or W-2VI to the Scala, &fetidly
Administration. File Copy 1 of Form W-3S$ end Copy I of Form W.2A5.
Cat. No, 101178
FTCOD23
EFTA00176034
I
22222.
M
mi% No, i im:Rion
ecittiCfnrnhtr
or Oftkdot Unn Doly. >
h.
InintHlratinn nilinbar
• 66-6567418
"flaW,:lele,acgmb:arellawce
6100 RED, HOOK QUARTER B-3
ST. THOMAS U.S.VIRGIN , 00802
580 -06 -2353
n
crnployne'å tirei norro nl~rl intur M
tau namn
DALE
BASTIAN GORDON
P.O. BOX 115
ST. THOMAS, VI, 00804
Krmployaek Puldrneu and 7.3; e:0110
,Ar
t 7Z/A P Y;71r
r
1 1.441.örneemanUen
,4
59388.04
3 %atal ne." "0"
n Mi—cart;invZosi
7
—".
65471.10
[._r:r
. rs1
)3.
14 'oor
is
.t rogg •sosully Ug: usilthtl
6510.00
n VI Intr•rmile, 41W*1
ti
4059.21
kt kin:Ibm-3 Ovitt,l'h•44 949.32
Mnr.
i it
4.
io
3 :f.s,tk
entrail:W.
„
ib Sen PIMI Watt ilaliSintal
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C
86. 00
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FILER'S name
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