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Total wages (from all your W-2 forms)*

Total federal tax (from all your W-2 forms)*

What state did you work in?*

Total Social security taxes paid (from all your W-2 forms)

Total Medicare taxes paid (from all your W-2 forms)

Total state taxes paid

Tax Year*

Date of arrival in USA*

Date of departure from USA*

Citizenship*

Visa type*

Your contact details

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