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WWW.palcofirst.com Exemption Worksheet Interventionist Name: Interventionist DOB: / / Month Employer Name: Day Year Case ID: FAMILY MEMBER TAX EXEMPTION Interventionists who provide domestic or household
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Interventionist name is the name of the individual or organization who is providing intervention services.
Any individual or organization providing intervention services needs to file interventionist name.
Interventionist name can be filled out by providing the full legal name of the individual or organization providing intervention services.
The purpose of interventionist name is to identify the individual or organization providing intervention services.
The information that must be reported on interventionist name includes the full legal name, contact information, and the type of intervention services provided.
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