Document Number (FOIA) /ESDN (CREST):
Body:
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FORM w-a (Key. Aug. tnD%j ^~~ =arl x *.
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U. S. Treasury Department Lu ^.,
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Internal Revenue, Service. ......... _ ',^i
Print Lull name !:.T h 1.W -?~'=~ ?
City A/ ~_/1N1? 2t 1:4~f~xd ~!'~,n.
Print home address, ~~-_-- + +AT ~/a
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File this form with, 1. If SINGLE, and you daim an exemption, write the figure , j'
your employer. 0th
erwise,he musfWilh- 2. If MARRIED;, one exemption each for husband and wife if., not claimed, on+8npthen certificate' rv ~I e. . 7 z ~ z