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This form is interactive complete electronically and print! Page 1 of 1Request for Sick Leave Pool Income for Catastrophic Conditions Employee Application Revised 3/2016For Completion by the EMPLOYEEComplete

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This form is used for reporting interactivecomplete information.

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Entities meeting certain criteria as specified by the IRS are required to file this form.

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The purpose of this form is to provide the IRS with interactivecomplete information for tax purposes.

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Entities must report interactivecomplete information such as income, expenses, and deductions.