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[PDF File]Instructions for Form 5471 (Rev. December 2018)
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• Schedule G, lines 4, 5, and 6 are new. These lines are used to answer questions about base erosion payments and benefits under section 59A, interest or royalty amounts paid or accrued for which the deduction is disallowed under section 267A, and foreign-derived intangible income deductions under section 250. These lines were added to ...
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[PDF File]Application for Social Security Card
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9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST show the parents' Social Security numbers unless the parent was never assigned a Social Security number. If the number is not known and you cannot obtain it, check the “unknown” box. 13.
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[PDF File]Patient Health Questionnaire (PHQ-9)
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PHQ-9 Patient Depression Questionnaire For initial diagnosis: 1. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive
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[PDF File]Form W-9 (Rev. October 2018)
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5. Address (number, street, and apt. or suite no.) See instructions. 6. City, state, and ZIP code. Requester’s name and address (optional) 7. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding.
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[PDF File]VAMC SLUMS Examination - School of Medicine
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0-4 animals 5-9 animals 10-14 animals 15+ animals 7. What were the five objects I asked you to remember? 1 point for each one correct. 8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24. 87 649 8537 9. This is a clock face.
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[PDF File]TEXAS WORKERS’ COMPENSATION WORK STATUS REPORT
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Facility/Doctor Phone and Fax Numbers 10. Employer’s Fax Number or Email Address (if known) 8. Facility/Doctor Address (Street, City, State, ZIP Code) 11. Insurance Carrier ... Must take prescription medication(s) Advised to take overthe- -counter meds Medication may make drowsy (possible
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[PDF File]FL-150 INCOME AND EXPENSE DECLARATION
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Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.) FL-150 [Rev. January 1, 2019]
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[PDF File]Request for Social Security Earnings Information
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display a valid Office of Management and Budget control number. We estimate that it will take about 11 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
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[PDF File]Revised 8-2019 MVC Application for Oklahoma Certificate of ...
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If Tire Rim Size is in Excess of 19.5", Check here: Flood Damage Disclosure The owner/legal agent of owner of any vehicle, regardless of age, is to complete the following Flood Damage Disclosure.
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[PDF File]Removal and/or Inspection of a Motor Vehicle at a VSF
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5. completing Section Five. (Note: This section provides the authorization to inspect or remove the vehicle; may be different from the person named in Section 3) This document affects your legal rights and may give others access to your motor vehicle. If you do not understand this document or have questions, please consult
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[PDF File]Form 149 - Sales and Use Tax Exemption Certificate
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149 Sales and Use Tax Exemption Certificate. Form 149 (Revised 11-2018) ... If claiming utilities (electrical energy, gas or water), record account numbers, meter numbers, or other information as required by the vendor. All purchasers who are claiming an exemption for energy use must provide the
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