a Employee's social security number
Void 440 - 27 - 7593 OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
47 - 4261736 48484.07 1107.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
ALTITUDE ENERGY PARTNERS LLC 48484.07 3006.01
5 Medicare wages and tips 6 Medicare tax withheld
7197 W. DERRICK DR 48484.07 703.02
7 Social security tips 8 Allocated tips
CASPER WY 82 6 04
d Control number 9 10 Dependent care benefits
e Employee's first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
CHRISTIAN J HULL ,DD 1 7354.49
13 Statutory Fiettrement Thord-party 12b
1154 SW 77TH TERRACE employ. Ilan sick pay
OKLAHOMA OK 73139 n
14 Other
e
12c
C
cl
12d
d
.
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 Locality name
I . .
Form W— L
Copy D — For Employer
Wage and Tax
Statement 2019 Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see separate instructions.