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PRINTED: 10/21/2015 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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Printed 1021 department is for reporting income tax payments.
Individuals and businesses who have made income tax payments in the current tax year are required to file printed 1021 department.
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