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Total Earned Income Tax Withheld. 8. Date Period Ended MM/DD/YYYY. 2. Credit or Adjustment attach explanation. 9. Total Pages of This Return. 3. Total of Earned Income Tax Due line 1 minus line 2. 10. Total Number of Employees Listed. 4. Total Payments Made this Quarter. If there has been a change of ownership or other transfer of business during the quarter attach explanation and give name of present owner and date the change took place. CHANGE 5. Adjusted Total of EIT Due line 3 minus line 4. ...

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