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Rev. 1/16Date County or FFA Chaperone No. Last NameFirst Name(s)Mailing Dressage(s) (Jan. 1 current year)Street or P.O. Box, Town, State, Club NameNEBRASKA 4H AND FFA DAIRY IDENTIFICATION AFFIDAVIT See
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Division K general rules pertain to the reporting requirements for certain investment income and expenses on tax returns.
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