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HENDRICKS PEDIATRIC DENTISTRY pH: (317) 85281131411 S. GREEN STREET, #200BROWNSBURG, IN 46112 Fax: (317) 8528115PATIENT REGISTRATION Patient Name Birth date / / (First)(Middle)(Last)(Month/Day/Year)Nickname/Preferred
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PH 317 852-8113 is a form used for specific reporting purposes, typically related to business or tax compliance in the state of Indiana.
Entities or individuals who are subject to the reporting requirements specified by the Indiana Department of Revenue are required to file PH 317 852-8113.
To fill out PH 317 852-8113, one must provide accurate and complete information as required, including personal or business details, financial information, and any required signatures.
The purpose of PH 317 852-8113 is to ensure compliance with state reporting requirements, which may include tax obligations or other regulatory reporting.
Information that must be reported includes identification details, income, deductions, credits, and other relevant financial data as mandated by state regulations.
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