Fillable etf et 2340 form

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Department of Employee Trust Funds P.O. Box 7931 Madison, WI 53707-7931 EMPLOYEE REIMBURSEMENT ACCOUNTS PROGRAM AUTOMATIC PREMIUM CONVERSION WAIVER/REVOCATION OF WAIVER To waive your participation in Automatic Premium Conversion, complete Sections A and B. To revoke a waiver of premium conversion that you filed previously, complete Sections A and C. Sign and date this form and return to your payroll/staff...
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