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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15G55401/09/2017FORM
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The printed 0109 is a form used by the Department of Revenue for tax reporting purposes.
Individuals and businesses that meet specific tax criteria set forth by the Department of Revenue are required to file the printed 0109.
To fill out the printed 0109, taxpayers must provide their identification information, income details, and any relevant deductions or credits as specified in the instructions.
The purpose of the printed 0109 is to report income, deductions, and taxes owed to the Department of Revenue.
The printed 0109 must include taxpayer identification, total income, allowable deductions, tax credits, and the total tax liability.
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