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Revised 4/7/16×COR AUT×CORAUTHEALTH INFORMATION DISCLOSURE AUTHORIZATION STUDENT ATHLETE Full Student Name (First, Middle, and Last)emancipated minorAddressDate of Birth City, State, Parents Phone
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What is revised 4716?
Revised 4716 is a form used for reporting certain information to the relevant authorities.
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Individuals or entities who meet specific criteria are required to file revised 4716.
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Revised 4716 can be filled out online or by mail, following the instructions provided on the form.
What is the purpose of revised 4716?
The purpose of revised 4716 is to collect specific information for regulatory or compliance purposes.
What information must be reported on revised 4716?
Revised 4716 requires reporting of certain financial and non-financial information as specified by the authorities.
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