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Get CA DE 8686 2006

Me: Employer Name: Address: Address: Telephone Number: ( ) Telephone Number: ( R 5. Is your business/organization a public entity? Yes R ) No If Yes, please enter an "X" in the box next to the type of public entity that best describes your organization: R City R County R State R Federal R School District R Other (Specify) 6. Enter effective date of WS Plan (New or Renewal): / / Note: The earliest effective date for a new WS Plan is the Sunday prior to the "first contact date".

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