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Sworn Statement Certifying Food NOT Produced with Genetic Engineering NAME OF MANUFACTURER OR PRODUCER: ADDRESS: CITY:Fairfield Organics DBA Heavenly Organics106 S Green St Devastate: Iowa ZIP CODE:AGENT

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Individuals who do not qualify for any tax exemptions or deductions.

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No exemptionscban is a form used to report income tax information for individuals who do not qualify for any tax exemptions.

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Information such as income sources, deductions, and any other relevant financial details must be reported on no exemptionscban.

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