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You must complete a separate Form CT-4852 for each missing or incorrect Form W-2 or Form 1099R. General Information Social Security Number Home Address Number and Street Apt. How did you determine the amounts in Boxes 5 through 8 above If you received a Form W-2 showing federal wages and federal income tax withheld you must attach that form with Form CT-4852 to your Connecticut Income Tax Return. If you did not receive a Form W-2 but you file fed.

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