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SUMMIT COUNTY PUBLIC HEALTH REGISTRATION FORM Summit County Public Health 1867 West Market Street Akron, Ohio 443136901 Phone: (330) 9234891 Toll free: 1 (877) 6870002 Fax: (330) 9237558 Date: Patient
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Re ce ive d is a form used to report income received.
Individuals who have received income that needs to be reported must file re ce ive d.
Re ce ive d can be filled out by providing information about the income received and any taxes withheld.
The purpose of re ce ive d is to report income received to the tax authorities.
Information such as the amount of income received, the source of the income, and any taxes withheld must be reported on re ce ive d.
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