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FOR OF USELL1
2003STATE OF ILLINOIS
DEPARTMENT OF PUBLIC AID
FINANCIAL AND STATISTICAL REPORT FOR
LONGER CARE FACILITIES
(FISCAL YEAR 2003)I.DPH Facility ID Number:
Facility Name:0020438II.CERTIFICATION
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Fax 708-547-4067 refers to a specific fax number associated with a form or document submission, typically used for filing certain tax-related information or reports.
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