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Image Dermatology P.DATE: (Rev. 10/2019)PATIENT INFORMATION: Driver License Number: (REQUIRED) Name: Last First Middle Address City, State, Zip Sex: Primary Number: Work Ext Cell Phone Email Social
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Primary number work extension (ext) refers to the additional time allowed for filing primary number work documents, typically requiring specific information and forms to report financial or employment data.
Individuals or entities that need more time to file their primary number work documents are required to file for a primary number work extension.
To fill out the primary number work extension, you need to complete the designated form by providing your personal or business information, including the reason for the extension and any required financial data.
The purpose of filing a primary number work extension is to grant additional time to submit required documentation without incurring penalties for late submission.
The information required typically includes identifying details such as name, address, tax identification number, the reason for requesting the extension, and any financial figures relevant to the work being reported.
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