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.TV/. J.1 f, J/. !11/M, Y/ JT I 41)$1 /Lilt to)/ '1z #, /RRR, f Fiji 611n/r Rb up/I'd .if PVC AC?id t 11/t) Y)INDIVIDULLDECEASED Personnel FILE BEST COPY POSSIBLE POOR QUALITY ORIGINAL (r, '. Rt RECEIPT
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Lif vic acid11 t is a form used for reporting information about a taxpayer's life insurance policies and payments.
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