EPARTMENT OF THE TREASURY

[INTERNAL REVENUE SERVICE

>HILADELPHIA PA

001945.550629.10361.12939 1 MB 0.561 692

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PAULA

M

19255-0023

JEZAK

1170 FUNDY RD

VENICE

FL

34293

Date of this notice: 12-22-2023

Employer Identification Number:

93-4933417

Form: SS-4

Number of this notice: CP 575 G

For assistance you may call us at:

1-800-***-****

IF YOU WRITE, ATTACH THE

STUB OF THIS NOTICE.