Form 6559 - Transmitter Report And Summary Of Magnetic Media

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(SSA date of filing stamp)

OMB No. 1545-0441

6559

Transmitter Report and

Form

(Check one)

(Rev. January 2003)

Tax Year (19

or 20

Summary of Magnetic

United

Department of the Treasury

Media

States

Internal Revenue Service

Other

Page

1. Name and address of transmitter (include street, city, state and ZIP code)

2. Employer identification number (EIN) of

transmitter

3. Number of reporting media this file

Magnetic tape(s)

Diskette(s)

Cartridge(s)

5. Telephone number (Include area code)

4. Name and address of person to contact about this magnetic media file (Include street, city,

state and ZIP code)

6. Your inventory number

7. Type of data being reported (Check only

one)

W-2 Original

W-2 Reconciliation

W-2 Resubmittal

W-2c for W-2

Affidavit

Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and to the best of my knowledge and belief it is

true, correct and complete.

8. Signature

9. Title

10. Date

11. Employer Summary of Form W-2 Magnetic Media

Wage and Tip Information

Name of employer

Check if

Name of employer

Check if

MQGE

Other EIN