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FOR BHF USELL1
2016
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2016)I.DPH License ID Number:
Facility
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What is 100 n e 15th?
100 n e 15th refers to a tax form used for reporting income from rental real estate properties.
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Individuals or entities who receive rental income from real estate properties are required to file 100 n e 15th.
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