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Get Ftb 5722

Lity. Instructions: Complete this form, print it, sign it and mail to: FRANCHISE TAX BOARD EQUAL EMPLOYMENT OPPORTUNITY OFFICE MS A163 PO BOX 550 SACRAMENTO CA 95812-0550 Grievant Information Grievant Name Address City Home Phone (include area code) Business Phone (include area code) ( ( ) State State ) ZIP Code ZIP Code Person (other than Grievant) Alleging an ADA Violation Name Address City Home Phone (include area code) Business Phone (include area code) ( ( ).

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