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Declaration of preparer other than officer is based on all information of which preparer has any knowledge. Sign Here Date Signature of officer Type or print name and title Print/Type preparer s name Preparer s signature Paid AMY BIBBY Preparer DIXON HUGHES GOODMAN LLP Firm s name Use Only 500 RIDGEFIELD COURT Firm s address ASHEVILLE NC 28806 Check if self- employed Firm s EIN Phone no. The organization qualifies as a publicly supported organization 17a 10 -facts-and-circumstances test...
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