Healing Hands Ministries Employer Statement Of Income

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Employer Statement of Income
______________
Date
_______________________________________________ currently works for me doing
(Name of employee)
_______________________________________________. He/She is paid the GROSS
(work employee does for payment)
amount before any deductions of $_____________ on a weekly / bi-weekly / monthly
(--------------circle one---------)
basis. This employee has been employed by me or the company for at least 4 weeks and
does not have health insurance through me or the company.
_____________________________________________
Signature of employer
_____________________________________________
Printed name of employer

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