EFTA Document EFTA01479213

Sheet1 Payer Name Payer Address(1) Payer Address(2) Payer City Payer State Paye r Zip Code Payer EIN Payer TCC Recipient Name Address (1) Address (2) Addr ess (3) City State Zip Code Foreign Country Recipient TIN Customer Account Number 1099 Type Taxable Amount Box 3 (other Income) Federal Tax Withheld (Box 4) Nonemployee Compensa tion (Box 7) State Tax Witheld(Boxl6) State Income (Box 18) State of Domicile Memb ership Value Higest State Marginal Tax Rate State Income Tax Itemized Deduction Limit Itemized Deduction for State Tax Taxable Federal Income Highest Federal Tax Rate Fede ral Income Tax Total Tax Reported Income Highest State Marginal Tax Rate State Income Tax Itemized Deduction Limit Itemized Deduction for State Tax Taxable Federal Income High est Federal Tax Rate Federal Income Tax Witheld AK2=1912.8306251222298 AR2=744.1189639864492 AM2=168.71166113578067 AK2=1912.8306251222298 NY 1000 (VLO0KUP(AA2,Sheet2!$A$2:$B$35,2,FALSE))=0.0882 (AB2*AC2)=88.20 0.20 (AD2*AE2)=17.64 AB2- AF2=982.36 0.396 (AG2*AH2)=389.01456 (AD2+A12)=477.21456 (+AB2/(1000-A.72))*1000=1912. 8306251222298 AC2=0.0882 (AK2*AL2)=168.71166113578067 0.20 (AM2*AN2)=33.74233222715613 (AK2-AO2)=1879.0882928950737 0.396 (AP2*AQ2)=744.1189639864492 For internal use only EFTA01479213 Sheet2 State of Domicile NY 0.0882 WA For internal use only Higest State Marginal Tax Rate EFTA01479214 Sheet3 Highest Federal Tax Rate 0.396 For internal use only EFTA01479215