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Form 2159 Payroll Deduction Agreement

Form 2159 (November 2016) Payroll Deduction Agreement (See Instructions on the back of this page.)Department of the Treasury internal revenue ServiceCatalog No. Form 2159 (Rev. 11-2016)TO: (Employer name and address)Regarding: (Taxpayer name and address)Contact Person s NameTelephone (Include area code)Social security or employer identification number(Taxpayer)(Spouse, last four digits)EMPLOYER See the instructions on the back of Part 2. The taxpayer identified above on the right named you as an employer. Please read and sign the following statement to agree to withhold amount(s) from the taxpayer s (employee s) wages or salary to apply to taxes owed.

Form 2159 (July 2018) Payroll Deduction Agreement (See Instructions on the back of this page.) Department of the Treasury — Internal Revenue Service

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