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GLEANER LIFE INSURANCE SOCIETY 5200 West U.S. Hwy. 223 P.O. Box 1894 Adrian, Michigan 492217894 800.992.1894 FAX 517.265.7745 WEB www.gleanerlife.org EMAIL gleaner life.org HIV Test Informed Consent
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Indicate the tax period for which you are submitting the form.
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Calculate your taxable income and enter the appropriate values.
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Submit the filled-out form to the relevant tax authority.

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