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1BEFORE THE STATE OF WASHINGTON OFFICE OF INSURANCE COMMISSIONER2 3In the Matter of:Docket No. 1600504 56 7 8 9The Form A and Form E Applications for the Proposed Acquisition of Control of:DECLARATION

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The form is used to report certain information to the IRS.

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The purpose is to report specific information to the IRS for tax compliance purposes.

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The form requires information such as income, expenses, deductions, and credits.

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