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State of California in lieu of IRS W-9 or W-7 STD 204 Rev. 03/2021 Section 1 Payee Information NAME This is required. Do not leave this line blank. Should my residency status change I will promptly notify the state agency below. NAME OF AUTHORIZED PAYEE REPRESENTATIVE TITLE SIGNATURE DATE TELEPHONE include area code Section 6 Paying State Agency Please return completed form to STATE AGENCY/DEPARTMENT OFFICE UNIT/SECTION FAX CITY STATE ZIP CODE GENERAL INSTRUCTIONS Type or print the information...
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