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EFTA00175998
MAS, usVI 00802 12 For thirdparty sick pay use arty ' cr Employer° address and ZP oaf, 14 Income tax whrilidd by payer of third-party dot pay h Othir EIN used sae year 16 Oheck the eppropriete bas Typo k W-2A$ W-2Cal W-2OU W-2Vl I Employer's tonitoriel ID numb& Fonn jr 0 si 0 us zr Conta
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