Print clear 501(rev. 1/12) fiduciary income tax return mailing address: georgia form georgia department of revenue processing center p.o. box 740316 atlanta, georgia 30374-0316 page 1 for filing year or other tax year change in trust or estate...
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Ref: stb-001 reception issues antenna, cabling and the set top box a digital set top box (stb) is only as good as the signal it receives. an stb can only store information for the signals received. there are a number of links in the chain from the...
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Email: info thecabinetjoint.com customer information acct # (if any) order date name address purchase order address 2 city state zip special shipping instructions customer information (required) phone fax email drawer box information all drawer...
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Ab cde po box 1827 medford or 97501 regence medadvantage (ppo) plan to plan enrollment form dear regence medadvantage member: to make a change in the medicare advantage plan you have with regence blueshield of idaho, fill out the enclosed plan...
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For office use only patient type i. demograf a del paciente amount of w/o $ nombre del paciente: s/a results: h/h $ (apellido/last) (nombre/first) (segundo nombre/middle) facility account # (no. de seguro social/ssn)
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Protective life insurance company p.o. box 830619 birmingham, al 352830619 individual life insurance application for reinstatement policy number: section i policy and insured information 1. insured(s) insured 1 name: (first, middle, last) gender...
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Please use the enclosed order form to request valley transit tickets. follow the instructions below. instructions: 1. 2. 3. 4. write the service date. print the participant name, address and phone number. complete the number of items (tickets,...
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J.h. fletcher & co. p.o. box 2187 huntington, wv 25722 304 . 525 . 7811 dear valued customer, at j.h. fletcher & co. we are commited to exceeding our clients expectations through the quality of our products. customer feedback is important in...
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Jacksonville dietetic association po box 550580 jacksonville, fl 32255 .eatrightjax.org food choices for renal patients a simplified renal diet based on the national renal diet. this is a 17 x 11 inch foldout developed by the renal practice group...
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Flying particles, inc. po box 1109, livermore, ca 945509 contact membership vp: doug homoelle (925)4227435 a nonprofit ownership flying club .flyingparticles.org application for membership full legal name date of birth home telephone occupation...
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Department of management & budget office of retirement services .michigan.gov/ors (800) 3815 p.o. box 30171 lansing mi 489097671 beneficiary nomination for public school employees members name (last, first, m.i.) date of birth member id or ssn...
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Plumbers & pipefitters local no. 520 health and welfare fund participants statement p.o. box 6480, harrisburg, pa 17112 7176718551 fax (717)6718602 disability claim form participant name date of birth social security number home phone # address...
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Non profit organization us postage paid saginaw, mi permit no. 52 benefits learn from the foremost authorities in the field of lifelong learning technology and best practices. po box 9 river falls, wi 54022 usa take home valuable strategies and...
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Perkins local plan (plp) template .. section 02: performance data analysis and improvement plan . cte teachers to assist with math remediation that will be held during the incetive to programs based on the number of
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28a-15-13. opening and inventory of decedent's safe-deposit box. (a) definitions. the following definitions apply to this section: (1) institution. any entity or person having supervision or possession of a safe-deposit box to which a
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