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PRINTED: 12/19/2018 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:HARRISON AT EAGLE VALLEY, THE
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Printed 1219 department is a form used to report income tax withheld on payments made to non-resident individuals or entities.
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Any individual or entity who makes payments to non-resident individuals or entities and has withheld income tax from those payments is required to file printed 1219 department.
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The information that must be reported on printed 1219 department includes the payer's details, recipient's details, payment details, and the amount of income tax withheld.
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