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Payer:
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| Payer's Federal Identification Number (FIN):340727612 |
| DEFENSE FINANCE AND ACCOUNTING SERVICE | |
| CLEVELAND CENTER | |
| 1240 EAST NINTH STREET | |
| CLEVELAND, OH 44199-2055 | |
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Recipient:
| |
| Recipient's Identification Number:
361-56-9005 |
| MANTIONE CHARLES | |
| MARYVILLE, TN 37804-4227 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 361569005RET01 |
| Distribution Code Value: | Normal distribution |
| Distribution Code: | 7 |
| Distribution Code Value: | Not significant |
| Distribution Code: | Blank |
| Tax Amount Undetermined Code: | Not checked |
| Total Distribution Code: | Not checked |
| First Year Roth Contribution: | 0000 |
| SEP Indicator: | IRA/SEP/SIMP box not checked |
| FATCA Indicator: | not FATCA |
| Date of Payment for Reportable Death Benefits under Section 6050Y: | 00-00-0000 |
| Tax Withheld: | $643.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $10,132.00 |
| Taxable Amount: | $10,132.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
