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PRINTED: 07/07/2020 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X3) DATE SURVEY COMPLETED 06/30/2020STREET
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Form SC 5027-A is a tax form used to report certain information related to income or assets.
Individuals or entities meeting specific criteria set by the tax authorities are required to file Form SC 5027-A.
Form SC 5027-A should be filled out by providing accurate information in the designated fields according to the instructions provided by the tax authorities.
The purpose of Form SC 5027-A is to gather information related to income or assets for tax reporting purposes.
Form SC 5027-A requires reporting of specific details such as income sources, asset information, and other relevant financial data.
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