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Get Ssa 754 F4 Form

Items on this form requiring an answer must be answered or marked "Unknown." I understand that the information given by me will be used in connection with an application filed for insurance benefits payable under Title II of the Social Security Act, as amended, based on the earnings of the wage earner or self-employed person named below. The following information is given pursuant to the Privacy Act of 1974. The Social Security Administration is authorized to collect information about your mar.

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