Form 11 - Municipal Tax Form Page 2

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SECTION
B
11LF05B
MUNICIPALITY
WORKPLACE WAGES
WORKPLACE
WORKPLACE
RESIDENCE TAX
TAX RATE
TAX WITHHELD
WITHHELD
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
Page
2
11LF13

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