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Payer:
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| Payer's Federal Identification Number (FIN):941737782 |
| CHARLES SCHWAB & CO., INC. | |
| 9800 SCHWAB WAY | |
| LONE TREE, CO 80124-0000 | |
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Recipient:
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| Recipient's Identification Number:
551-69-3182 |
| JASON FOX | |
| 758 E WHITEHALL RD | |
| COOKEVILLE, TN 38501-0000 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 54863668 |
| Interest: | $0.00 |
| Tax Withheld: | $0.00 |
| Savings Bonds: | $0.00 |
| Investment Expense: | $0.00 |
| Interest Forfeiture: | $0.00 |
| Foreign Tax Paid: | $0.00 |
| Tax-Exempt Interest: | $0.00 |
| Specified Private Activity Bond Interest: | $0.00 |
| Market Discount: | $0.00 |
| Bond Premium: | $0.00 |
| Bond Premium on Tax Exempt Bond: | $0.00 |
| Bond Premium on Treasury Obligations: | $0.00 |
| Second Notice Indicator: | No Second Notice |
| Foreign Country or US Possession: | |
| CUSIP Number: | |
| FATCA Filing Requirement: | Box not checked no Filing Requirement |
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Payer:
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| Payer's Federal Identification Number (FIN):871192148 |
| CELSIUS NETWORK LLC | |
| 221 RIVER STREET | |
| HOBOKEN, NJ 07030-0000 | |
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Recipient:
| |
| Recipient's Identification Number:
551-69-3182 |
| JASON FOX | |
| 758 E WHITEHALL RD | |
| COOKEVILLE, TN 38501-0000 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | CUPXXN4HFN6AVUZEB7GL |
| Tax Withheld: | $0.00 |
| Medical Payments: | $0.00 |
| Fishing Income: | $0.00 |
| Rents: | $0.00 |
| Royalties: | $0.00 |
| Other Income: | $1,172.00 |
| Substitute Payments for Dividends: | $0.00 |
| Excess Golden Parachute: | $0.00 |
| Crop Insurance: | $0.00 |
| Attorney Fees: | $0.00 |
| Foreign Tax Paid: | $0.00 |
| Section 409A Deferrals: | $0.00 |
| Nonqualified deferred compensation: | $0.00 |
| Fish Purchased for Resale: | $0.00 |
| Direct Sales Indicator: | Not Direct Sales |
| FATCA Filing Requirement: | Box not checked no Filing Requirement |
| Second Notice Indicator: | No Second Notice |
