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Mark "X" only one box. [2 Yes — Go to Addressee Title or Department ATTN. Street 1 Street 2 ... Cumulative salaries since the beginning of the calendar or fiscal year Payroll amounts from last fiscal year ... and hours for the pay period that includes March 12. 2017 Payroll for Part-time Employees Part-time Number of Payroll Part-time Employees ................
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