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Mississippi Public Service Commission Lifeline Assistance Form Name of Service Provider: First Name: MI: Last Name: Last 4 digits of Social Security Number: Tribal ID #: Residential Physical Address:
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Customers or clients who are requesting services from a specific provider.
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The name of the service provider is the entity or individual responsible for providing a specific service.
The entity or individual who is providing the service is required to file the name of the service provider.
The name of the service provider can be filled out by providing the legal name or business name of the entity or individual providing the service.
The purpose of providing the name of the service provider is to clearly identify and acknowledge the entity or individual responsible for providing the service.
The information that must be reported on the name of the service provider typically includes the legal name or business name of the entity or individual providing the service.
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