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Get B1 1 Form 2003-2024

Name (last name, first name, middle initial) Street address Social security number Date of birth Age Grade City ZIP Code Home telephone 2271 West Louise Avenue Manteca 95337 (209) 858-0832 Street address City ZIP Code School telephone Manteca Unified School District School name For Employer to Complete (Please review rules for employment of minors on reverse.)  Name of business Street address City ZIP Code Business telephone Minor’s work duties Hourly wage Maximum .

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