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Print designee s name Third-party designee see instr. Yes No Designee s phone number E-mail Preparer s signature Paid Preparer s NYTPRIN preparer must Firm s name or yours if self-employed complete Preparer s PTIN or SSN see instr. Address Personal identification number PIN Date Self-employed Sign return here Signature of fiduciary or officer representing fiduciary Daytime phone number. G If a grantor trust enter the identification number SSN or EIN of the individual reporting the...
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