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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F62470 (06/2016)STATE OF WISCONSIN Wis. Stat. 50.04(2t)(b), 50.035(5)(b), and 51.64(2)(a)Wis. Admin. Code DHS 88.03(5)(e)1-Page 1 of 5 CLIENT
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042tb 50 is a tax form used to report certain types of income, such as interest and dividends.
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