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Get PA DoR 83-A272A 2010

For tax purposes. General Regulation Section 306 (2) provides that the employer, for and on behalf of the employee, requests the refund. AUTHORIZED OFFICIAL SIGNATURE (Signature must be clear and legible.) PRINTED NAME DAYTIME TELEPHONE NUMBER EMPLOYEE CERTIFICATION I HEREBY CERTIFY that the statements contained herein and in any supporting schedule or exhibit are true and correct to the best of my knowledge and belief. I understand that if I knowingly make any false statements herein, I am s.

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