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Get Us Dol Payroll Form Wh 347 - Ded Mo

Ilnd Hour Division Rev. Dec. 2008 ADDRESS NAME OF CONTRACTOR OR SUBCONTRACTOR OMS No.: 1215-0149 Expires: 12/31/2011 IRS # PAYROLL NO. PROJECT AND LOCATION PROJECT OR CONTRACT NO. FOR WEEK ENDING (4) DAY AND DATE (5) (6) (7) ,.; (1) NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER) OF WORKER (2) NO. OF WITHHOLDING EXEMPTIONS (3) WORK CLASSIFICATION (8) DEDUCTIONS (/) 0: (9) NET WAGES PAID FOR WEE.

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