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N, Indiana, Kentucky, Missouri, and Iowa (If you do not live in a Border State, skip to Tax Information) * Have you performed work in Illinois at any time during the last 18 months while living in a border state? Yes No * Do you plan on looking for work in IL? Yes No * Are you temporarily laid off for 10 weeks or less from an Illinois employer? Yes No Yes No Yes No Tax Information (Illinois residents only) * I elect to have Federal Income Tax withheld from my gross Unemployment Insu.

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