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PRINTED: 06/10/2016 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 0614 is a form used by the Department of Taxation and Finance for reporting certain tax-related information.
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Taxpayers who meet specific criteria related to income and business activities are required to file printed 0614.
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