Department of the Treasury- Internal Revenue Service                                                      Tax period ended
Form 4977
(Rev. February 2002)                                                            Schedule of Tax Liability
Name                                                                                                                                                                        Employer Identification Number

Number, street, and room or suite no.                                                                                                                                       Telephone number (optional)

City or town, state, and ZIP code                                                                                                                                           This form supports adjustments to:
                                                                                                                                                                              Form 1042
                                                                                                                                                                              Form 940

Section I.                                                                             Form 1042, Withholding Tax

LineNo.   endingPeriod    (includingTaxonliabilityForm(s)any taxesfor1000)periodassumedLineNo. endingPeriod    (includingTaxonliabilityForm(s)any taxesfor1000)periodassumedLineNo. endingPeriod   (includingTax liabilityForm(s)any taxesfor1000)periodassumed on

 1                     7                                                               21                   7                                                               41                   7
 2                     15                                                              22                   15                                                              42                   15
        Jan.           22                                                              23      May          22                                                              43      Sept.        22
 3
 4                     31                                                              24                   31                                                              44                   30
 5      Jan. total                                                                     25      May total                                                                    45      Sept. total
 6                     7                                                               26                   7                                                               46                   7
 7                     15                                                              27                   15                                                              47                   15
 8      Feb.           22                                                              28      June         22                                                              48      Oct.         22
 9                     28                                                              29                   30                                                              49                   31
 10     Feb. total                                                                     30      June total                                                                   50      Oct. total
 11                    7                                                               31                   7751
                       15                                                                                   15                                                                                   15
 12                                                                                    32                                                                                   52
        March          22                                                                      July         22                                                                      Nov.         22
 13                                                                                    33                                                                                   53
                       31                                                                                   31                                                                                   31
 14                                                                                    34                   1                                                               54
 15     Mar. total                                                                     35      July total                                                                   55      Nov. total
 16                    77 7                                                            36                                                                                   56
                       15                                                                                   15                                                                                   15
 17                                                                                    37                                                                                   57
        April          22                                                                      August       22                                                                      Dec          22
 18                                                                                    38                                                                                   58
                       30                                                              39                   31                                                              59                   31
 19
 20     Apr. total                                                                     40      Aug. total                                                                   60      Dec. total
 61 Total liability for year (add monthly total lines from above)                                                                                                                                61
Section II.                                                                            Form 940, Unemployment Tax
              Quarter                                                                                         Liability for Quarter (Do not include state liability)
 First
 Second
 Third
 Fourth
 Total
                                         Under penalties of perjury, I declare that I have examined the above liability schedule,
                                         and to the best of my knowledge and belief, it is true, correct, and complete.
Signature                                                                              Title                                                                                        Date

Form 4977 (Rev. 02-2002)                                                                                    Catalog Number 42142L