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Form[removed]B (Rev. August 2000)
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Document Date: 2015-03-09 14:32:10

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City

Philadelphia / Rancho Cordova / /

Company

Class A Preferred Stock XYZ Corporation / /

Country

United States / /

Currency

USD / /

Facility

Western Area Distribution Center / /

IndustryTerm

real estate / /

Movie

Power of Attorney / /

Organization

Internal Revenue Service Center / Western Area Distribution Center / Department of the Treasury Internal Revenue Service / Tax Forms Committee / FIRPTA Unit / Internal Revenue Service / /

Position

attorney / Representative / trustee / dealer / responsible corporate officer / /

ProvinceOrState

California / Pennsylvania / /

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