ACC 401 ASSIST Motivated Minds/acc401assist.com ACC 401 ASSIST Motivated Minds/acc401assist.com | Page 29

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 Identifying number: 33-XXXX011