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Es were paid) 2011 00 3 # of W-2s attached or employees reported on magnetic media Please print the address below. Tax Year 00 Signature Title 00 Complete back of form Date Telephone Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and belief, it is true, correct, and complete. (Do not send payment with this report.) Annual Reconciliation of Louisiana Withholding Tax F.

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