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PATIENT INFORMATION Welcome to Northeast Pediatric Associates, P.A. Please provide the following information. Patient Name: Date of Birth: Home Address: (Circle one: Cell, Home, Work, Other)Primary
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Circle one cell home is a form used to report certain information about a person's primary residence.
Individuals who own a primary residence are required to file circle one cell home.
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The purpose of circle one cell home is to assess property taxes and determine eligibility for certain exemptions.
Information such as residence address, ownership details, occupancy status, and any exemptions must be reported on circle one cell home.
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