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Clear Form FOR REVENUE USE ONLY Date Received O R E G O N D E PA R T M E N T OF REVENUE REQUEST FOR DOUBTFUL LIABILITY RELIEF Taxpayer s Name s Social Security No. / Other Identifying No. Taxpayer s Street Address City State ZIP Code Please complete the following if known for routing purposes only Revenue Employee Division/Section Check the tax program s for which you are requesting doubtful liability relief. Tax Years Personal Income Corporation...
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