ACC 401 ASSIST Great Stories /acc401assist.com ACC 401 ASSIST Great Stories /acc401assist.com | Page 26

Taxes withheld:
Federal: $2795.28
Social Security: $3016.49
Medicare: $704.98
State: $658.63
sdi (mandatory disability insurance): $379.55
Employer: CompanyOne
Address: 1111 Place Road
City: One City
State: California
Zip code: 11112
Employer’s FED ID number: 33-01XXX22
Dependent:
Tara Petersan
SSN: 001-XX-XX00
DOB: 12/29/2004
Child Care Costs: $10,320
Child Care Provider: fabulous daycarecenter
Address: 121 Place Road
City: One City
State: California
Zip code: 11111