(1) (2) (3) (4) (5) (6) (7) (8) (9)
S Date Date Enter State Local State Local Prorated
t Lived in Lived in Total Sales Sales Sales Sales or Total
a State State State & Tax Tax Tax Tax Amount
t From To Local Rate Rate (%) Table Amount
e Rate (%) (%) (4) - (5) Amount
EFTA01222146
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