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TC 962 6/88 TRANSPORTATION CABINET Department of Vehicle Regulation Division of Motor Vehicle Licensing Frankfort, KY 40622 STATEMENT OF EMPLOYER SUPPLYING MOTOR VEHICLE Name of Employer: Address:
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In the following section, indicate whether you are an individual, a business, or another entity by checking the appropriate box.
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Fill in your taxpayer identification number (TIN) or employer identification number (EIN) if applicable.
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Now, provide the date on which you are completing the form.
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