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[[pre-printed]]
EARNINGS and WITHHOLDING TAX
Date Earnings Tax
[[/pre-printed]]

Jan. 14 Complete Income $2786.35
Expenses [[?]].15
Income on $1014.20

[[strikethrough]][[?]] $12.00[[/strikethrough]]

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40.

[[pre-printed]]
EARNINGS and WITHHOLDING TAX
Date Earnings Tax
[[/pre-printed]]