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Dd columns (a) and (b).) 1 Travel and lodging payments for expenses of moving from old to new home. Do not include meals (b) Amount paid to a third party for employee s benefit and value of services furnished in kind 2 All other payments (list type and amount). Note: These amounts must be included in the employee s income and are subject to withholding 3 4 Total. Add the amounts in column (c) of lines 1 through 3 Instructions for Employees Purpose of Form This form is furni.

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