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Get NY Coupon Form to Employer 2011-2024

E payment was withheld from the employee's/obligor’s wages. You may send a single check for all employees/obligors or individual checks as long as one coupon per employee/obligor is included for each pay date. Please indicate the pay date and the dollar amount withheld on each coupon. Income Withholder Name and Address: SEND CASH Payments must be remitted within seven business days of the date the respondent is paid. You must return this coupon with your payment to the address on the coup.

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