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Get DE WCWT-5 - Wilmington 2015

O. (RFD NO.) STREET NAME CITY OR TOWN STATE ZIP CODE PRESENT EMPLOYER NAME ADDRESS OTHER EMPLOYER NAME ADDRESS HOME TEL. NO. WORK TEL. NO. Please read and follow all instructions explicitly before filing the application. General Instructions: 1. You must attach a copy of your W-2 that shows both federal and local wages. 2. An authorized signature must be obtained from your employer. Other substantiation may be substituted only with the express consent of an authorized employee of the.

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