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Get CT DRS CT-W4 2015

Educed 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 penalty of law that I have examined this certi cate and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for reporting false information is a ne.

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