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Get OR 150-211-055 2005

N the back. • You must fill in the date employees were first paid. • Please type or print. Date received E/R code Business name County NAICS Type of Ownership (check one): Corporation Political Campaign Other Nonprofit Individual (sole prop. ) Person at business authorized to discuss your payroll account with us Government–Federal (attach federal exemption) Limited Liability Part. (LLP) Ext. Government–State Non-profit 501(c)(3) Single Member LLC Business telephone .

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