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Disbursement Detail
ABC COMPANY: 565011JOHN SMITH: XXX-XX-1234
| $2,000.00 | |
| 04/02/YYYY | |
Tax Information
| Federal Tax Withheld | $560.00 |
| State Tax Withheld | $130.00 |
| State Code | CT |
| Tax Year | YYYY |
General Distribution Information
| Federal Excess Type | 7 Normal |
| Distribution Type | 4 Hardship |
| Reason | Primary Residence |
| Related Participant Number | XXX-XX-1234 |