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MENZADO EL de de Y TERMINADO EL de de N mero de Identificaci n Patronal Nombre de la Entidad N mero de Serie 20 GOBIERNO DE PUERTO RICO DEPARTAMENTO DE HACIENDA PLANILLA ENMENDADA A O CONTRIBUTIVO: 1 NATURAL 2 ECON MICO 3 52-53 SEMANAS: A o contributivo comenzado el D A / MES A O y terminado el / D A / MES A O / 4 D A / MES A O PER ODO CORTO: Comenzado el / D A / MES.

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