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197 Talbot Street West, Suite 101 Lexington, Ontario, N8H 1N8 PH: 5193221100 FAX: 5193222055 REQUEST TO BE A PATIENT FORM This is only a request.
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You can fill out 5193221100 by providing accurate income information and following the instructions on the form.
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Income sources, deductions, credits, and total tax liability must be reported on 5193221100.
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