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Use at nnrgovete. | Employee Reference Cop) W-2 ‘Wage and Tax 2009 2009 W-2 and EARNINGS SUMMARY = (>> ‘This blue Earnings Summary section I included with your W-2 te help deseribe portions In “The reverse sido includes general information that you may also find helpful. otal [> Enpojers Feb ID nanber |= Exponessssk nomi —| Wage SSR 25 — 2 Feat noes oa 427.74 308.77 ase eoeemene 1.-The following informetion reflects your final 2009 pay stub plus any adjustments submited by your emple le ttonsatnenber"f bapt—|— Cone peace Gross Poy (4448.67 Social Securit 265.77 NY. State Income Tax 158.97 [0017 66/906 3 o Tox Wiha” Bax 17 of W2- bee > Empresa at Boctat We fesieoere 27.56 KEMPINSKI INTERNATIONAL Fedlmeame 427.74 Madea Tox cole Exide Sst wise surso1 8.20 608 STH AVE sozane Eneste SniPa we Ste Woi0, NEW YORK, NY 10017 2, Your Gross Pay was adjusted as follows to produce your W-2 Statement. Batch 200770) i Wages, Tips, other NY. State Wages, NEWYRKCY Social Security Medicare yar nan, CATE Se Gempensation Tips Ete, | Local ages, Weggs 0 Wages AMADOU DOUMBIA ae a eine Sat Smee 201 W. RD STREET rs Pay 4440.67 4,440.87 4,448.67 4,408.97 4,448.67 226 ‘Less Trans. Benefit 162.00 162.00 162.00 162.00 162.00 NEW YORK, NY 10025 Fopored W-2 Wages 4,296.67 a,286.67 4,206.87 4,206.67 «4,286.67 8 Employee W-4 Profil. Ta change your Employee W-4 Profil infomation flea new Wt with your payroll dept AMADOU DOUMBIA 201 W. 3RD STREET 2G ‘Sect! Sacuty Numbo.004 92-5452 Tasable Mart Stan, SINGLE xemptons(lowanese! [ NEW YORK, NY 10025 FEDERAL: 1 Sy State t ny rocasesees rm 6.67 toca 1 150.97 e667 a oo 0 re. SS eT | eon | wae ae. trv "weer err 280.87 1 SST pgs] SATE | FSS ae 1ST warns || Recon gee "3356.67 era meee Be5:77 | we "a868 67 cn aa [0 Wa ao saa | [Swear ane eat Ear 2.16 “2.10 “Base eraser | Ba] Con Ean an] Ele) | ]F~Ganernomar Do | Con” | Ear a oot7 6608 2 2 || [0017 ess0e | 2 IKEMPINSK! 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Br 3HO STREET ewe sap street Zor W SAO STREET 226 |,;226 22G [Rew york, wv to02s IINEW YORK, Ny 10028 NEW YORK, NY 10025 PERE ag | LR RE, | | Peano Par aaa aon fare a ea sse.a7 Sie. | 189.87 fse.e7 sso | eT ae PoeEiracr | r "Tenancy ST or sg PP eKcY | ————reasral Fling i Fiing:cop Cligor Leal Fling Copy Be siae ian tax ! ) Wage and Tax epiWayeanditae 3 Wr Mine 2009 | eutmtent Wed 2h cron 2009 cotta oie ae sl | sae corte naer eS 4009FOR MW) Windy Gates Soho Inc. 568 Broadway Suite 401 New York, NY 10012 (Copy 8 To Bo Filed With Employee's use For EMPLOYEE'S RECORDS FEBERAL rm eum 2009 vers] | GwNatceioenpyreonbacrartone) 200s Eines cal | IWR R ASAT —PFodearnare inated) (a enojeisaca [1 Waps ip ohercors-— Fatratneone sci rambo 82.22 SSrroer 92022 94-92-5452 | FamaTaany Migs —_—TESSTHETTTERIT] © |_(094- 92-5452 | seacaaany nape eS TR ee De 82.22 5.20] | | enorme 82.22 5. 4133842325 | Simsemnvapansees eae TT 13-3842325| Saao EES _— Umer 82.22 1.29] 82.22 Les TESA, SIPS al Fae | Windy Gates soho Inc. | 568 Broadway suite 401 | New york, Ny 10012 | cesar To WR 3423 1532 3800 Dourbia Amadou 34231532 3800 Doumbia Amadou TESS RS RTRES Cetra 3 ETRE ol are wT — Ca Amadou.Dounbia |_amadou.._.Doumbia 201 West 93rd Street apt No. 220 201 West 93rd Street Apt No. 226 New York, NY 10025 New York, NY 10025 Sete aaa TCR | Teli | STS Pra Cama "1 Depart care bats | 1¥ Nenqualfa plans Oe | pane eae onan Renal pare ia ae Sane STIS TOT mr a Say ane TFT 5 Oe aR jaca set ar SSR ra Ca sR Z We] 33-3640325 82.22 Ny] s-sean325 82-22 by sttenane ie spe tror'ssui0 6 [teatewogeip cS ones Lessa "Bost tate yates sy “Slew York, Ny 32 poe York, We Teal oe Teas Forma Wane ard Tax tment Dat ioe roman FS ‘Tinta tang iaton ome RS. we racunstgisatacren sass rears aoe anyon reset Copy 2 Tee Fed With Emplyeas Ste, ty oral income ax et 200! Tabs Pied Wh Employee's Ste, 5 Loea nce far Rts [2009 22% ‘pepe sooe | 1 eps os aarcarp. ——[2Fasoal irene arwPVald)_| SEnpleyessrocel 1 Waste tsa amp. [2 Fetaincone awa rer nanan 2022 Esc nee ao 22 94-92-5452) seareaniymape —_—[7Satseamyirwarna| | | 094-92-5452| smatseamiymags a aa | Rteone Danie] 82.22 5.10) | -eeeae Ramer 82.22 5.10] 13-3842325| sicarevage mare [ener eIE 13-3842325| ShaaaIEE ECS |e MeeaTaINE 32.22 1.19] 82.22 1.19] FEROS SIR IPS "SEBS nas Sa EDP Windy Gates soho Inc. Windy Gates Soho Inc. 568 Broadway Suite 401 568 Broadway Suite 401 New York, NY 10012 New York, NY 10012 3423 1532 3800 Dounble Arado "34231532 3800 Donia anadou “Ele a FSIS an nae | | eereopasnerenssaransl Catron Amadou Doumbia Amadou —Doumbia 201 West 93rd Street Apt No. 226 201 West 93rd Street Apt No. 226 New York, NY 10025 New York, WY 10025 eles sans, 087 cost {raoees esa, ond 2 xe TS Seay | SORTS [aor EC eRe Tce eer ps ATS aaa CSR perc eats 1 NeranaozpoR YER Cae DoE ae TE Naas $B a are TAR ee Say aa TORT aie ROVER Ry | ra Re Ta ome Ny] 13-3843335 2.22 T3-3842325 82.22 sate Enotsesiot0.t | 6 sia noes tee Ince spss enarewieio.# |rsmiewsgin tenets lt sitercara im renee toes tees wope fc OTas eet (her York, xx 82.22 New York, 3 Desk oe Tey RS | Form W2 Wage and Tax Sinton Dept ofthe Teseury RS | eeeearexsNEW YORK STATE DEPARTMENT OF LABOR PAYMENT UNIT, BUILDING 12 1038-6 PO BOK 21 ALBANY, NY 12201-0624 A DOUMBIA 50 WEST 72ND ST. 1611 NeW YORK ny 10023 ‘Do You Qualify For An Earned Income Credit? You may be ented to a Federal tax cred. The amount ofthe credit is based on your eared income such 28 ‘wages and saitemployment. This cred may be alowee leven Ifyou Go not owe any Federal income tax However, you must fle @ Federal income tax return to ‘obiain the credit. See the instuctions on your Federsl income tax forms to determine ithe amount of your income allows you to claim this credit, Important Information About Form 1099-6 New York State is required to report the unemployment compensation payments of $10 or more, that you received last year, tothe Infernal Revenue Selves: end to furnish you wilt Form 1098-G by Jeruary STF this year. Unemployment compensation includes: ‘© Unemployment Insurance payments © Extended Benefits and Federal Supplemental Compensation payments © TAA (Trade Adjustment Act) baste, retroactive, and ‘daltional traning payments ‘© DUA (Disaster Unemployment Assistance) payments, Please keep Form 1099-G for your records. You wil need this information to compete your Federal, State and Local income tax stuns. If you a not receive any unemployment compensation this year, but repaid an ‘overpayient, his form is being sent in case it wil be of help to You Note: Unless you have voluntarily authorized Federal or State withholding, Federal, State and Local income taxes are nol withheld on unemployment ‘compensation. I you exiect fo receive these benefits inthe future, You cen ask the payer fo withhold Federal and State income tax from each payrnent ©, you can make estimated tax payments during the year. For mare Information regarding how to make estimate tax payments, see instructions ‘on the appropriate ta return, or, contact the Intemal Revenue Service othe NYS Department of Taxation and Finance, BOX 1 Shows the otal unemployment compensation pai to you this yee. For tax year 2008, combine the box 1 amounts from all Forms 1089-G, and ‘report the amount in exness of 82,400 as incame onthe unemeloymart ‘compensation line on your return. this 1098-6 is fora year other than PAYER'S name, street address, cy, state, ZIP code, Federal denificalion number, and telephone number NEW YORK STATE DEPARTMENT OF LABOR-UNEMPLOYMENT INSURANCE ALBANY, N.Y. 12240-0001 PAYER'S Fed. Id, No. 27-0203117 Phone 518 485-7 2008, swe the instructions on the appropriate tax return, or contact {he internal Revenue Service, the NYS Department of Taxation and “Finance oF Your focal faxing authority to determine the amount of {taxable unemployment insurance, Box 2 Shows adjustments credited to you this year. Adjustments Include money we receWved Inclucing cach (money ordars and personal checks) in repayment of an overpayment. Current unemployment ‘compensation Used fo repay (offset) existing overpayments, not included inthis amount. Adjustment information may be helpful to you in fling your return, [BOX 4 Shows total Federal income tax withheld fom unemployment ‘compensation paid to you this year. (i you voluntary authorized ‘eatnholaing, ex has been witihatd at a 70% rate) Include tox withheld, any, on your Income tax return BOX Shows Altemative Trade Adjustment Assistance (ATAA) payments you receNved. This amount is not included in Box t amounts, BOX 10a Shows the payers state, BOX 10b Shows the payer's Federal dertiction Number. [BOX 11 Shows total State income tax withheld from unemployment ‘compensation paid to you this year. (Ifyou voluntanly authorized -wthnoldng, tax has been withheld at a 2.5% rat.) Inoue tax withheld Hany, on your income tax return, [ows No 1545-0720 [Statement for [Recipients of Certain Government Payments 2009 [Form 1089-G (11/09) RECIPIENTS Wentiication number |, Unemployment compensation 094-92-5452 912,065.00 2 Adjustments |. 30.00 “4 Federal income fax withheld $1,206.50 RECIPIENTS name, sleet address, cly, sate and ZIP code A DOUMBIA So WEST 72ND ST. 1611 NEW YORK ny 10023 SATA Payments | 6 $0.00 7 & 3 Wa] 100 State | 11. State income tax wines State | Identication No ny__ | 27-0280017 30.00 This is important tax information and s being furnished o the Internal Revenue Service Tyou are required to fie a return, @ negligence pray or olher senction may be imposed on you i this income is taxable and the IRS determifes thet has nt been reportedC1 cORRECTED (if checked) 25-1693362 XK XK-5452 EGER TCENOETS naw wi aa Ta? i SS AMERICAN EDUCATION SERVICES Student Peon pax beet HARRISBURG, PA 17105 2009 Loan Interest Boocess-0587 ‘Statement Form 1098-E TEENS ea Sane BORROWERS OSH SGA AE 1 Shue ar rs eos a copys 1,096.54 For Borrower ‘BORROWERS name AMADOU DOUMBIA 50 W 72ND ST APT 1611 NEW YORK, NY 10023-4260 ‘This import ax Isormaton ands being fanshod oe na ovenve Serves Fyou ‘sro roquted'o tes fetum, snegigence pend orb aecton |e betrmnos tht ‘cout nba (ee0 evUCTONE) PPA TH eRaced BoR des wal nee a resote because overstated adeduclon {or iodon oan berest fpignaton tas nr canoes erent or fos made eloe Sapee 1, 2004 fa Fom 1098-E (keep for your records) ‘Deparnent ofthe Treasury - ntmal Revenue Senco You are receiving a 1098-E for the Tax year 2009. This form should replace any information you may have received from us recently. 'Box 2" is checked above, the total in "Box 1” does not \d/or capitalized interest on any loans ma ude payments made to the lender to satisty before September 1, 2004. If you have loans. made before September 1, 2004, you may be able to deduct additional amounts not included in "Box 1”. If you have any questions about allowable deductions for the interest and/or origination fees paid on your loans, please contact a tax professional. If your address or telephone number has recently changed please provide this information to your servicer. Your servicer name, address, and telephone number”. instructions for Sorrower—— - A person (including a financial institution, a govemmental unit, and an educational institution) that receives interest payments of $600 or more during the year on one or more qualified student loans must furnish this statement to you. ‘You may be able to deduct student loan interest that you actually paid in 2009 on your income tax. return, However, you may not be able to deduct the fuli amount of interest reported on this statement. Do not contact the recipientlender for explanations of the requirements for (and how to figure) any allowable deduction forthe interest aid. Instead, for more information, see Pub. 970, ‘ax Benefits for Education, and the *Student Loan interest Deduction Worksheet” in your Form 1040 or 1040A instructions, identified in the upper left hand comer of this form, in the box titled "Recipient's/Lender’s ‘Account number. May show an account or other unique number the lender assigned to distinguish your account. Box 1. Shows the interest recelved by the lender during the year on one or more student loans, made to you. For loans made on or after September 1, 2004, box 1 must include loan origination fees and capitalized interest received in 2009. If your loan was made before September 1, 2004, you may be able to deduct loan origination fees and capitalized interest not reported in box 1 Box 2. If checked, indicates that loan origination fees andlor capitalized interest are not included in box 1 for loans made before September 1, 2004. ‘See Pub. 970 for how to figure any deductible loan origination fees or capitalized interest.