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Withholding, Check One of the Following: Texarkana, ARKANSAS (resident within city limits only) Texarkana, TEXAS (resident within city limits only) The above information is correct as of this date: Under penalty of perjury, I certify that the above information is true and if there is a change in my status, I will notify my employer within seven (7) days after the change occurs. Signature Date INSTRUCTIONS FOR THE TEXARKANA EXEMPTION CERTIFICATE Any employee who qualifies for the exemption sho.

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