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INITIALS DATE: City of Eagle Point OFFICE USE ONLY 17 Buchanan Ave, P.O. Box 779 Eagle Point, OR 97524 (541)8264212 Fax:(541)8266155 ACH Debit Authorization Direct Payment I (we) hereby authorize
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Box 779 Eagle Point is a section on a tax form where specific information related to taxable income from certain sources is reported.
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