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Form 31603FORM APPROVED OMB No. 10040136(August 1999)Expires November 30, 2000UNITED STATES DEPARTMENT OF THE INTERIOR5. Lease Serial No. UT ST UO01194STBUREAU OF LAND MANAGEMENT6. If Indian, Allotted

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The UT ST UO-01194-ST is a tax form used for reporting certain information to the tax authorities.

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Details as requested by the tax authorities for the specific reporting period.

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