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PRINTED: 10/1412016FORM APPROVEDIMSDH Health Facilities Licensure and Certification ELEMENT OF DEFICIENCIES “AND(X1) PROVIDERISUPPUER/Chapman OF CORRECTIONIDENTIFICATION(X2) MULTIPLE CONSTRUCTIONNUMBER:a.

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Printed 101412016 is a specific form or document required for reporting certain financial information, typically related to tax filings or regulatory compliance.

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Individuals or entities that meet specific criteria set forth by the relevant tax authority or agency are required to file printed 101412016.

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The purpose of printed 101412016 is to collect and report relevant financial information to the appropriate regulatory body or tax authority.

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Information that must be reported on printed 101412016 may include income, deductions, credits, and other financial details as specified by the form.

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