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Get Ri Tx-16 2019

M FOR REFUND OF TEMPORARY DISABILITY INSURANCE TAX IMPORTANT - Please read instructions before completing 1. Enter your Name, Social Security Number, and Address. YOUR NAME (First, Middle Initial and Last) SOCIAL SECURITY NUMBER - - NO. AND STREET CITY STATE ZIP CODE 2. Enter the calendar year for which a refund is being claimed, filing date, your signature , and telephone number. I hereby apply for a refund of taxes paid in excess during the calendar year to the R.I. Temporar.

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