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El state income tax withholding deductions for a state other than California. (Refer to the income tax withholding regulations of the state in which you are earning compensation.) PERSONAL INFORMATION NAME (last, first, middle) Campus UCSB Campus Department HOME ADDRESS (Number, Street) (City, State, Zip) Employee No. Social Security No. Campus Phone: (with Area Code) E-Mail Address: IF YOU ARE A NONRESIDENT OF CALIFORNIA, COMPLETE THIS SECTION I am a nonresident of the state of California.

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