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Payment to Agency Report Agency Name Public DocumentPAYMENT TO AGENCY REPORT1.division, Department, or Region California QA4 Form OW 1. Date Stamp “City of San Jose (it is applicable). 'IJ** V i

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Start by downloading or obtaining the California QA4 form.

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Submit the filled-out form to the relevant California tax office either by mail or electronically, as per the instructions provided.

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