EFTA00176006

b. Employee identification number (EIN) 13-3643429			1 Wages, tips, other compensation 60000.00		2 Federal income tax withheld 6065.04
c. Employer's name, address, and ZIP code EPSTEIN INTERESTS 457 MADISON AVENUE NEW YORK, NY 10022			3 Social security wages 60000.00		4 Social security tax withheld 3720.00
			5 Medicare wages and tips 60000.00		6 Medicare tax withhold 870.00
			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 Suff.			11 Nonqualified plans		12a See instructions for box 12
			Statutory employee	Retirement plan	Third-party安保	12b
			Statutory employee	Retirement plan	Third-party安保	12b
			f. Employee's address and ZIP code				14 Other	12c
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 Locality name

Department of the Treasury—Internal Revenue Service Copy D—For Employer.

	TOTALS
For: Batch No. 2006/4/00859	1 TOTAL EMPLOYEES
For: Company 66/LMB	31.20	NYDD (Box 14)
1 FORMS
	60,000.00 State Wages (Box 16)
	3,063.96 State Income Tax (Box 17)

E1002 EFTA00176007 | OMB No. 1645-0008 LMB

b Employer identification number (EIN) 13-3643429				1 Wages, tips, other compensation 60000.00		2 Federal income tax withheld 6065.04
c Employee's name, address, and ZIP code EPSTEIN INTERESTS 457 MADISON AVENUE NEW YORK, NY 10022				3 Social security wages 60000.00		4 Social security tax withheld 3720.00
				5 Medicare wages and tips 60000.00		6 Medicare tax withhold 870.00
				7 Social security tips

d Employee's social security number 451-11-5768				9 Advance EIC payment		10 Dependent care benefits
e Employee's first name and initial LESLEY GROFF 120 OAK STREET NEW CANAAN, CT 06840				11 Nonqualified plans		12a See instructions for box 12
				13 Senior employee	Retirement plan	Third-party sick pay	12b
				14 Other 31.20 NYDD		12c
				14 Other 31.20 NYDD		12d
f Employee's address and ZIP code
15 State NY	Employer's state ID number 13-3643429	16 State wages, tips, etc. 60000.00	17 State Income tax 3063.96	18 Local wages, tips, etc.		19 Local income tax	20 Locality name

Form W-2 Wage and Tax Statement Department of the Treasury—Internal Revenue Service Copy D—For Employer. For Privacy Act and Paperwork Reduction Act Notice, see back 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
					5 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 Suff.					11 Nonqualified plans	12a See Instructions for box 12
					13 Statutory employee	Retirement plan	Third party sick pay	12b
					14 Other		12c
					14 Other		12d
f Employee's address and ZIP code
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 Locality name

For Employer. Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see back of Copy D. E1003