## EXHIBIT A EFTA00090812

a. Contact number		Void
b. Employer identification number (EIR)				1 Wages, tips, other compensation 7890.65	2 Federal income tax withheld 714.35
c. Employer's name, address, and ZIP code JEPFREY E. EPSTEIN 358 EL BRILLO WAY PALM BEACH, FL 33480				3 Social security wages 7890.65	4 Social security tax withheld 489.22
				5 Medicare wages and tips 7890.65	6 Medicare tax withheld 114.41
				7 Social security tips	8 Allocated tips
				d. Employee's social security number		9 Advance EID payment	10 Dependent care benefits
e. Employee's first name and initial Last name Suft.				11 Nonqualified plans	12a See instructions for box 12 C 6.00
				13 Practice number	14 Practice number	12b
				14 Other		12c
				14 Other		12d
f. Employee's address and ZIP code
15 state	Employer's state ID number	16 state wages, tips, etc.	17 State income tax	18 Local wages, tips, etc.	19 Local income tax	20 Local name

- For Employer. Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see back of Copy D. MM16-31E-MM-108062-GJ-1A SEC 003 SER 1A9-1A16-000332 3524-003 Page 4 of 6 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7,8,9,10,15,and 17 EFTA00090813

a. Control number	Void		0017
b. Employee identification number (EIN)			1 Wages, tips, other compensation 38536.47		2 Federal income tax withheld 3463.23
c. Employee's name, address, and ZIP code JEFFREY E. EFSTEIN 358 EL BRILLO WAY PALM BEACH, FL 33480			3 Social security wages 38536.47		4 Social security tax withheld 2389.26
			5 Medicare wages and tips 38536.47		6 Medicare tax withhold 558.78
			7 Social security tips		8 Allocated tips
			9 Advance DC payment		10 Dependent care benefits
e. Employee's social security number			11 Nonqualified plans		12a See instructions for box 12 C 28.62
			13 Security amount	14 Insurance plan	12b
			13 Security amount	14 Insurance plan	12c
			f. Employee's address and ZIP code
15 State Employer's state IDnumber FL	16 State wages, tips, etc.	17 State income tax		18 Local wages, tips, etc.	19 Local income tax	20 Local area

Department of the Treasury—Internal Revenue Service Copy B—For Employer. For Privacy Act and Paperwork Reduction Act Notice, see track of Copy D

a Control number		Void
b Employer identification number (EIN)				1 Wages, tips, other compensation	2 Federal income tax withheld
c Employer's name, address, and ZIP code				3 Social security wages	4 Social security tax withheld
				6 Medicare wages and tips	6 Medicare tax withheld
				7 Social security tips	8 Allocated tips
d Employee's social security number				9 Advance EIC payment	10 Dependent care benefits
e Employee's first name and initial Last name				11 Nonqualified plans	12a See instructions for box 12
				13 Senior enrolment	14 Membership	15 Thriftgage status	12b
				14 Other			12c
							12d

f Employee's address and ZIP code
15 Star	Employer's state IC number	16 State wages, hps, etc.	17 State income tax	18 Local wages, hps, etc.	19 Local income tax	20 Local name

MM16-31E-MM-108062-GJ-1A SEC 003 SER 1A9-1A16-000333 3524-003 Page 5 of 6 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7,8,9,10,15,and 17 EFTA00090814