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# Document EFTA 00006066
| a Control number<br>66/18E<br>0017 | Vold | OMB No. 1545-0008 18E | | | | | 0017 | | |
|----------------------------------------------------------------|----------------------------|------------------------------------|-------------|--------------------------------------------|---------------------------------|---------------------------------|--------------------------------------------------------------------------------------------------------------------------------------|--|--|
| Employer identification number (EIN) | | | 1 | Wages, tips, other compensation<br>7890.65 | | 2 Federal income tax withhold | 714.35 | | |
| c Employer's name, address, and ZIP code<br>JEFFREY E. EPSTEIN | | | | Social security wages<br>7890.65 | | 4 Social security tax withheld | 489.22 | | |
| 358 EL BRILLO WAY<br>PALM BEACH, FL 33480 | | Medicare wages and tips<br>7890.65 | | | Medicare tax withheld<br>114.41 | | | | |
| | | | | Social security tips | 8 Allocated tips | | | | |
| | | | ದಿ | Advance EIC payment | 10 | Dependent care benefits | | | |
| | Loam | Suff. | 11 | Nonqualified plans | C | 12a See instructions for box 12 | 6.00 | | |
| BEACH, FL 33139<br>MIAMI | | | Other<br>14 | Third-party<br>sick pay | 12b<br>12c | | | | |
| Employee's address and ZIP ood | | | | | 12d | | | | |
| Employer's state ID number<br>15 State<br>eL | 16 State wages, tips, etc. | 17 State income tax | | 18 Local wages, tips, etc. | 19 Local income tax | | 20 Locally name | | |
| | | | | | | | | | |
| Wage and Tax<br>Statement | | 10000 | | | | | Department of the Treasury -- Internal Revenue Service<br>For Privacy Act and Paperwork Reduction<br>Act Notice, see back of Copy D. | | |
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| a Control number<br>66/18E<br>0017 | Void | OMB No. 1545-0008 18E | | | 0017 | |
|--------------------------------------------------------------|----------------------------|-----------------------|-------------|---------------------------------------------|----------------------------------------------------------------------------|--|
| Is Employor identification number (EIN) | | | r | Wages, tips, other compensation<br>38536.47 | Federal income tax withheld<br>3463.23 | |
| Employer's name, address, and ZIP code<br>JEFFREY E. EPSTEIN | | | | Social security wages<br>38536.47 | Social secunity tax withheld<br>2389.26 | |
| 358 EL BRILLO WAY<br>PALM BEACH, FL 33480 | | | | Medicare wages and tips<br>38536.47 | Medicare tax withheld<br>e<br>558.78 | |
| | | | 7 | Social security tips | Allocated tips<br>8 | |
| | | | 0 | Advance EIC payment | Dependent care benefits<br>10 | |
| | | | 11 | Nonqualified plans | 12a See instructions for box 12<br>EC | |
| BEACH, FL 33139 | | | 13 Subutory | Resuement<br>There-party<br>Sick pay<br>224 | 28.62<br>12b | |
| | | | Other<br>14 | | 120 | |
| | | | | | 12d | |
| Employee's address and ZIP code<br>- | | | | | | |
| 15 State<br>Employer's state ID number<br>FL | 16 State wages, tips, etc. | 17 State income tax | | 18 Local wages, tips, etc. | 19 Local income tax<br>20 Locality name | |
| | | | | | | |
| Wage and Tax<br>Statement<br>Form | | 2005 | | | Department of the Treasury-Internal Revenue Service | |
| Copy D-For Employer. | | | | | For Privacy Act and Paperwork Reduction<br>Act Notice, see back of Copy D. | |
| 年為 | | | | | | |
| | | | | | | |
| a Control number | Void | OMB No. 1545-0008 | | | | |
| b Employer identification number (EIN) | | | 1 | Wages, tips, other compensation | 2 Federal income tax withheld | |
| c Employer's name, address, and ZIP code | | | ന | Social security wages | 4<br>Social security tax withheld | |
| | | | ਦ | Medicare wages and tips | Medicare tax withheld<br>6 | |
| | | | 7 | Social security tips | Allocated tips<br>8 | |
| d Employee's social security number | | | ਰੇ | Advance EIC payment | Dependent care benefits<br>10 | |
| e Employee's first name and initial<br>Last name | | | 11 | Nonqualified plans | 12a See instructions for box 12 | |
| | | | 13 Sundary | Reivement<br>sex pay<br>רומן | 12p | |
| | | | Other<br>14 | | 3<br>12c | |
| | | | | | 12d | |
| f Employee's address and ZIP code | | | | | | |
| 15 State<br>Employer's state ID number | 16 State wages, tips, etc. | 17 State income tax | | 18 Local wages, lips, etc. | 19 Local income tax<br>20 Localty name | |
| | | | | | | |
| Wage and Tax<br>Statement | | | | | Department of the Treasury-Internal Revenue Service | |
'or Employer.
For Privacy Act and Paperwork Reduction
.
|