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Form 31603 (September 2001)FORM APPROVED OMB No. 10040136 Expires January 31, 2004UNITED STATES DEPARTMENT OF THE INTERIORLease Serial No.5.UTU69061BUREAU OF LAND Management Indian, Allotted or Tribe

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j- ig-g is a specific tax form used for reporting certain types of income for tax purposes.

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