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PRINTED: 12/17/2020 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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Printed 1217 is a form used by the Department of Revenue for reporting specific types of income and tax obligations.
Individuals or businesses that meet certain income thresholds or tax liabilities as defined by the Department of Revenue are required to file printed 1217.
To fill out printed 1217, gather all necessary income documents, follow the instructions provided with the form, and accurately report all required information.
The purpose of printed 1217 is to report income and calculate the corresponding tax owed to the state.
Information such as total income, deductions, and tax credits must be reported on printed 1217.
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