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[PDF File]Form 1957 - Bill of Sale or Even-Trade Bill of Sale
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The seller must complete all applicable information and sign this form. The Bill of Sale or Even-Trade Bill of Sale must be notarized when showing proof of ownership on major component parts of a rebuilt vehicle or when specifically requested to be notarized by the Department of Revenue.
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[PDF File]Instructions for Form 2848 (Rev. January 2018)
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Page 2 of 6 Fileid: … ns/I2848/201801/A/XML/Cycle08/source 13:17 - 23-Jan-2018 The type and rule above prints on all proofs including departmental reproduction ...
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[PDF File]Request for Social Security Earnings Information
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Form . SSA-7050-F4 (03-2019) Page 2 of 4. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . 1. Provide your name as it appears on your most recent Social Security card or the name of the individual whose
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[PDF File]Form I-693, Report of Medical Examination and Vaccination ...
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section of the Form I-693 Instructions before completing this section. You must submit Form I-693 in a sealed envelope to USCIS as directed in the Form I-693 Instructions. 1. Applicant's Statement Regarding the Interpreter A. (USPS ZIP Code Lookup) At my request, the preparer named in . Part 4., 2.
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[PDF File]National Interagency Coordination Center 0530 MT National ...
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National Interagency Coordination Center Incident Management Situation Report Saturday, September 28, 2019 – 0530 MT National Preparedness Level 1 National Fire Activity
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[PDF File]Form 149 - Sales and Use Tax Exemption Certificate
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Caution to seller: In order for the certificate to be accepted in good faith by the seller, the seller must exercise care that the ... 149 Sales and Use Tax Exemption Certificate. Form 149 (Revised 11-2018) Select the appropriate box for the type of exemption to be claimed and complete any additional information requested.
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[PDF File]VAMC SLUMS Examination - School of Medicine
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SH Tariq, N Tumosa, JT Chibnall, HM Perry III, and JE Morley. The Saint Louis University Mental Status (SLUMS) Examination for Detecting Mild Cognitive Impairment and Dementia is more sensitive than the Mini-Mental Status Examination (MMSE) - A pilot study. J am Geriatri Psych ( in press). 2 3 Questions about this assessment tool? E-mail aging ...
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[PDF File]Patient Health Questionnaire (PHQ-9)
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PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME: DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day (use " ü " to indicate your answer) 1. Little interest or pleasure in doing things 0 1 2 3
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[PDF File]2018 Form 8867 - Internal Revenue Service
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referenced in 4b, a copy of this Form 8867, a copy of any applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form 8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the taxpayer that you relied on to
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[PDF File]Application for Social Security Card
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Form SS-5 (08-2011) ef (08-2011) Destroy Prior Editions. Page 1. Application for a Social Security Card. Applying for a Social Security Card is . free! USE THIS APPLICATION TO: Apply for an original Social Security card
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[PDF File]TINETTI BALANCE ASSESSMENT TOOL - Welcome to CHHD Home Page!
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TINETTI BALANCE ASSESSMENT TOOL GAIT SECTION Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. Risk Indicators: Tinetti Tool Score Risk of Falls ≤18 High 19-23 Moderate ≥24 Low Date Indication of gait (Immediately after told to ‘go’.) Any hesitancy or multiple attempts = 0 No hesitancy = 1
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