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SOCIAL SECURITY NUMBER OR ANY OTHER NUMBER OF IDENTIFICATION SHOWN ON DOCUMENT TELEPHONE NUMBER AT WHICH WE CAN REACH YOU DURING THE DAY ( ) or ( ) TYPE OF TAX: (CHECK APPROPRIATE BOX AND INDICATE YEAR S ) Year(s) Gross Income Tax Corporation Business Tax** Sales Tax** Business Personal Property Tax** W-3 /NJ-500** Other** ** Requests for copies of Corporation, Sales, NJ-500/W-3 or Business Personal Property Tax must be submitted on company stationery and signed by an officer of the comp.

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