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S contained herein and in any supporting schedule or exhibit are true and correct to the best of my knowledge and belief. I understand that if I knowingly make any false statements herein, I am subject to such penalties as may be prescribed by City Ordinance. EMPLOYEE'S SIGNATURE (Signature must be clear and legible.) DATE 83-A272 Rev. 12-4-2014 INSTRUCTIONS FOR FILING WAGE TAX REFUND PETITION (Commission Employees Only) You must attach the applicable W-2 indicating Federal, Medicare, State.
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