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Get 57 mo 2014-2024

Ddress of Contractor or Subcontractor: City: Name of Public Body For Week Ending / AWO Phone Number: ( ) - State: ZIP: Phone Number: ( ) - Project and Location Project or Contract No. / 3. Day and Date 1. Name and Address of Employee ZIP: Address of Public Body: City: Payroll No. State: 2. Occupational Title *** Day Date Hours Worked Each Day DT OT ST DT OT ST DT OT ST DT OT ST DT OT ST DT OT ST DT OT ST DT OT ST 6. Gross Amt 5. 4. Hourly FICA Total Rate Project and Hours .

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