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Get NJ Form NJ-2440 2022-2024

O. Periods of Sickness From To Number Paid Days Minus Initial Period Allowable Sick Days x Daily Rate of Pay x x x x x x x x x Sick Pay Total Sick Pay For Year This is to certify that the payment(s) set forth above meet all three criteria in N.J.A.C. 18:35-2.3 Authorized Signature of Employer Title Date Gross Income Tax Employee Accident or Health Insurance Exclusion N.J.A.C. 18:35-2.3 18:35-2.3 E.

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