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									Kansas City, Missouri Earnings Tax Deduction Form


I,___________________________________ (please print), request that the City of
Prairie Village withhold the Kansas City, Missouri Earnings Tax from my paycheck. I
understand that the amount withheld from check will be itemized on my W-2 at the end
of the year and that filing returns or other information required by Kansas City Missouri
is my responsibility.


_______________________________________________ (signature)


______________________ (date)



For Payroll Use Only:

______ Entered in Millennium

______ Verified by_________




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