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Get Form Va 4

Or exemption from withholding is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. Your first name and middle initial 2 Last name Home address (number and street or rural route) 3 Single Married 2012 Your social security number Married, but withhold at higher Single rate. Note. If married, but legally separated, or spouse is a nonresident alien, check the Single box. City or town, state, and ZIP code 4 If your last name differ.

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