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A Member Information Name SSN B Annual Salary Information Church/organization name PIN Effective date of change reported on this form mm/dd/yyyy Number of hours scheduled to work per week e*g* 25 30 40 Please enter annual amounts or zero if not applicable. 1. Cash salary including employee contributions to 403 b 9 plans tax-sheltered annuity plans unvouchered book car and study allowances 1. vacation pay and overtime 2. Housing allowance utilities and furnishings allowances 3. Employing organiz ...

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