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Medicaid Provider Application Utah Department of HealthPROVIDER NUMBERED A COPY FOR YOUR RECORDS RIGHT HALF FOR STATE USES EE SEPARATE SHEET FOR INSTRUCTIONSNEW1. NAME 2. TELEPHONE NUMBER TO ADDRESS(4.3.
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Right half for state is a form used to report state tax information.
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Individuals and businesses who earn income in the state are required to file right half for state.
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