Application For 2007 Emst Refund Form - Capital Tax Collection Bureau Page 2
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2Employment Information: (List all places you are or were employed for the tax year. If listing self-
employment write "SELF" under employer's name column. If full time employment mark (FT)
and part-time mark (PT))
Phone Number/
Municipality within which
Employer's Name
-------------------
you worked for this
Gross earning for this tax
& Local Address
Date Employed
employer
year
1
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$
2
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$
3
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$
4
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$
5
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$
6
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$
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