HomeMy WebLinkAbout0746 I
1 ~ 1
ti
. S
j
4
1
• i
tjNITEQ STA~E$ b~ Al1AERI~A !
OFFICE OF PERSONNEL MANAGEMEN?
C1V11. SERVICE RETIREMENT SYSTE_ M
MASNINpTON, 0.0. lO~If `
1
1
• fvYP surd c1lEac EoR
Horace R. Smallwood S 1,120.13
Admin. Est. of Joseph E. Reino rosEI.A1LEO.T
2225 Sgarger Rd. ~
D~~rham, NC 2?705 ~ 9 ~
INTEREST (INCLUDED :N AtOVEj
TWIS iS A FINAL STATE11ilENT s
~ THE INTERNAL REVENUE fERVICE. TREASUAT
tinder the provisions of the Civil Service Retirement System, you a:e entitled to a lump sum DEPARTMENT. NAS ADVISED TII:?T HITEREST
payment because of the death of a former employee. This payment covers only benefits due ON CIVIL tERVICE RETIREYENr LUY? SUY
from the Cirif Service Retirement and disability Fund.
?ATMENTS LHOUID 0E REPORTED Af A'LONp
liAI1E OF DECEASED fORYER EYKOTEE - T[RM CAPITAL OAUt' FOR iFOERAI INCOME
TAX PilRPOSES. (IF THE lUM1 tUM ?AT4ENT
Joseph E • RelAO CONSIST ONLY OF VOLUNTMT CONTI119UT-
tlw~Y NUYaEA DATE Oi lWTH IONS` THIS MIKL 1E INDICATED IN THE
REMARKS SECTION AND THE INTEREST
C+SF 1 -250 262 0902/22 iNOUl06EREPORTEOASREGUIMINCOM1E.j
A E NARKS FOR ADDffiONAL tNFORYATION CONCERNUip
UN;OME TAX. PLEASE CONTACT THE C:REC-
TOII OF grTERHAI REVENUE FOR TOUR
DISTRICT.
~ NOTICE: IF' TOU NEED TO CONTACT U3
it FURTHER AYOUT THIS CASE, KEASE 01YE THE
FULL NAME, DATE OF rtRTH, /LND CLAN
I
j NUM.ER OF THE iORMEq EtiKOTEE SHOMIN
~ A80YE
i
•RI ti-SaS ~
f ?ART 1 - TO PAYEE RETIREMENT Cl.AIIWS tawT
{
1 : 'I
_ .
t
S
.
;f .
i
}
F{
3
S
i3g
i
f r
5u0~K ~P1~?J PAGE 7~