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Document ID 70126 August 17, 2016, D Stanza Donald Evergreen en Packaging g 5201 Fairfield Rd Pine Bluff, AR 71601 1 CERTIFIED C 199 9991 70 036 8381 802 22 / Return Receipt Re requested MAIL: 91

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99 9991 7036 8381 is a form used for reporting certain types of income to the IRS.

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