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DaVita Retirement Savings Plan HARDSHIP WITHDRAWAL …

DaVita Retirement Savings Plan HARDSHIP WITHDRAWAL APPLICATION HARDSHIP WITHDRAWAL / PAGE 2 of 4 CHOOSE TAX WITHHOLDING AND GROSS UP ELECTION Tax Withholding Elections:Regardless of whether or not federal or state income tax is withheld, you are liable for taxes on the taxable portion of the payment.

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