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5 In accordance with Chapter 37-13-13 it is mandatory that contractors use these forms for all Rhode Island Department of Labor requests for certified copies of payroll. Failure to submit information on these forms will constitute non-compliance by the responding contractor. Regular Overtime Hours Note Deductions reported in the other column must be listed. DLT-WRS-1 Rev. 10/11 STATEMENT OF COMPLIANCE I Owner do hereby state John Smith print name.

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