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PRINTED: 06/20/2018 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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1 Rose Street W is a form used for reporting certain types of income to the IRS.
Any entity or individual who paid reportable income to another party during the tax year may be required to file 1 Rose Street W.
To fill out 1 Rose Street W, you will need to provide information about the income paid, the recipient of the income, and other relevant details.
The purpose of 1 Rose Street W is to report income to the IRS for tax purposes.
Information such as the payer's name, address, and tax identification number, as well as the recipient's name, address, and tax identification number must be reported on 1 Rose Street W.
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