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PERSONAL REPRESENTATIVE APPOINTMENT AND
AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION
(For Farm Bureau Health Plan)
This form is used to authorize Farm Bureau Health Benefit Plan, LLC (Farm
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t-9620086 10-18 an-t revised is a revised version of a specific tax form.
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The purpose of t-9620086 10-18 an-t revised is to report specific information to the tax authorities.
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