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Reasonable Accommodation/Modification Disability Verification Form Name: Address: Phone: The person named above has a disability defined as a physical or mental impairment that substantially limits
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Provide the individual's date of birth, including the day, month, and year.
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The form is Form XYZ.
Individuals with income above a certain threshold are required to file Form XYZ.
Form XYZ can be filled out online or downloaded and completed manually.
The purpose of Form XYZ is to report income and calculate taxes owed.
Form XYZ requires information about income, deductions, and credits.
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