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DEPARTMENT OF HEALTH SERVICES
Division of Enterprise Services
F82064 (02/2014)STATE OF WISCONSIN
Chapters 48.685 and 50.065, Wis. Stats.
DHS 12.05(4), Wis. Admin. CodeBACKGROUND INFORMATION DISCLOSURE
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F-82064a is a form used for reporting financial information.
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The form should be filled out carefully and accurately, following the instructions provided by the IRS.
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