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Get MN DoR MWR 2017

Rm and give it to your employer. Employee s last name First name and initial Employee s Social Security number State (check one) Zip code Permanent address Employee Information City Michigan 1 If you earned wages in Minnesota during the previous year, enter the wages you earned. $ 2 I have lived at the above residence since (month and year) Employer Information (nearest dollar) . 3 Do you return to the above residence at least once a month? . . . . . . . . . ..

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