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OMB No. 12500003 Expires XX/XX/XXX VIA CERTIFIED MAIL (NUMBER) RETURN RECEIPT REQUESTED (Contractor Official) (Title of Contractor Official) (Establishment Name) (Street Address) (City, State, Zip
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This form expires on December 31, 2023.
Any organization or individual who meets the reporting requirements.
The form can be filled out online or by mail following the instructions provided by the issuing agency.
The purpose of this form is to collect specific information for regulatory or statistical purposes.
The form may require information such as name, contact details, financial information, or other relevant data depending on the specific requirements.
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