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FOR BHF USELL1 2018STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2018) I.DPH License ID Number:
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To fill out the PA Peterson AT Form, you can follow these steps: 1. Obtain the form from the relevant authority. 2. Read the instructions on the form carefully. 3. Enter your personal information, such as name, address, and contact details. 4. Provide the required details regarding the purpose of the form. 5. Fill in any additional information or supporting documents if necessary. 6. Double-check all the information provided for accuracy. 7. Sign and date the form as required. 8. Submit the completed form to the designated authority or organization.

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The purpose of the form is to report income to the tax authorities.
Income details such as amount earned, source of income, and any relevant deductions.
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