Srr Form - Claim From Non-Resident Of Stow For Tax Withheld By Employer Of Wages Earned Outside Stow - State Of Ohio Page 2

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THIS SECTION TO BE COMPLETED IN DETAIL
DATE
CITY & STATE
PURPOSE
COMPANY VISITED
CONTACT
HOURS
WORKED
7/20
Columbus, Ohio
Bid quote
XYZ Company
John Doe
4
Type or Print Employee’s Name

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