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Get Employer&amp - Tax Ny

For limits on exclusion, see instructions, Form IT-221-I. Employer s name Date you retired (if after December 31, 1976). Also enter this date in the space provided on the Physician s statement on back. Yourself Your Spouse (also give payer s name, if other than employer) Date of retirement Date of retirement Mark an X in the box if you did not live with your spouse during any part of the tax year. Which column(s) to fill in Use Column A to enter your disability income amo.

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