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I certify that I am responsible for reporting coverage information to the Wisconsin Retirement System. Date Signed MM/DD/CC/YY ET-2810 REV 2/2012 P065 Delete incorrect employment category Signature and Title of Agent ET-2810 Employee Identification Correction/Change ET-2810 - Field Requirements Fields Account Correction Codes P030 P031 P032 P033 P034 P035 P036 P063 1. 03 and 40. 07 See reverse side for field requirements for each type of account .

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