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MASS PLATINUM MEMBERSHIP APPLICATION Association: Name: (Last, First, Middle) Spouse: (Last, First, Middle) Birth Date: Member: / / Spouse: / Age: Member / Spouse: Mailing Address City: State: Zip:
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This form can be used for reporting financial information to the government.
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The purpose of this form is to provide the government with accurate financial information.
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Income, expenses, assets, and liabilities must be reported on this form.
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