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000000000000 IMPORTANT: MONTHLY AND QUARTERLY FILERS MUST FILE EACH RETURN REGARDLESS OF THE AMOUNT OF DELAWARE TAXES WITHHELD DURING THE PERIOD INDICATED. If you have questions, call (302) 577-8779. CHANGES MUST BE MADE ON THE REQUEST FOR CHANGE FORM. CHECK THE BOX IF YOU ARE FILING A CHANGE FORM. Mail This Form With Remittance Payable To: STATE OF DELAWARE DIVISION OF REVENUE P.O. BOX 8754 WILMINGTON, DE 19899-8754 Business Name and Mailing Address 1. DELAWARE INCOME TAX WITHHELD $.

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