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Reset Form PRIVACY NOTICE This agency is requesting disclosure of your Social Security number in accordance with IC 22-3-4-13. Signature of employer / adjuster Date issued month day year By U.S. Mail Personal Service FOR BOARD USE ONLY WORKERS COMPENSATION BOARD 402 W. Washington St. Rm. W196 Indianapolis IN 46204-2753. Must include details of first request above. Extraordinary circumstances which have precluded determination of liability Status of investigation Timetable for completion of...

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What is this agency is requesting?

This agency is requesting information related to tax filings.

Who is required to file this agency is requesting?

All individuals and businesses who meet the filing requirements must file with this agency.

How to fill out this agency is requesting?

The filing can be done online or through mail by completing the necessary forms and providing required documentation.

What is the purpose of this agency is requesting?

The purpose of this agency is to ensure compliance with tax laws and to collect accurate information for tax assessment purposes.

What information must be reported on this agency is requesting?

Income, expenses, deductions, credits, and any other relevant financial information must be reported on this agency.

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