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Get CT DRS CT-W4 2016

R chosen from above. ....................... 1. 2. Additional withholding amount per pay period: If any, see Page 3 instructions. .......... 2. $ and enter state of legal residence/domicile: 3. Reduced withholding amount per pay period: If any, see Page 3 instructions. ............ 3. $ First name Ml Last name Social Security Number Home address (number and street, apartment number, suite number, PO Box) City/town State ZIP code Declaration: I declare under penal.

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