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This form MUST be returned on or before 10/15 PREMIUM ONLY PLAN ELECTION FORM AND COMPENSATION REDUCTION AGREEMENT NAME SOCIAL SECURITY NO. ADDRESS I elect to participate in the I.R.C. Section 125
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This form is a tax form.
Individuals and businesses meeting certain criteria are required to file this form.
The form must be completed following the instructions provided by the tax authority.
The purpose of this form is to report income and taxes owed.
Information such as income, deductions, and credits must be reported on this form.
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