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PRINTED: 10/15/2015 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 0904 is a form used by the Department of Revenue for reporting certain tax-related information.
Businesses and taxpayers who meet specific income thresholds or require state tax reporting must file the printed 0904.
To fill out printed 0904, gather the necessary income and expense information, follow the instructions provided on the form, and provide all required details accurately.
The purpose of printed 0904 is to provide the state with detailed information about tax liabilities, ensuring compliance with state tax laws.
The printed 0904 must report income, deductions, exemptions, and other relevant financial data for the tax year.
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