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(Name and Address of Facility) ___ ___ ___Dear Sir/Madam: In order that the Social Security Administration may be advised of your intermediary preference, please indicate the organization you wish

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The term 'name and address of' refers to the identification information required to be submitted for individuals or entities in various official filings, typically including the full legal name and physical address.

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The information that must be reported generally includes the full legal name, physical address, and sometimes additional contact details such as phone numbers or email addresses, depending on the specific filing requirements.

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