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Ort for calendar year: OMB No. 1545-0029 2021 Check the quarter (same as Form 941): 1: January, February, March Name as shown on Form 941 2: April, May, June Type of filer (check one): Section 3504 Agent CPEO 3: July, August, September Other Third Party Read the instructions before you complete Schedule R. Type or print within the boxes. Complete a separate line for the amounts allocated to each of your clients. The term client as used on this form includes the term custo.

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