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BR_Medical_Authorization_Zachry_Exxon_v1a.premedical Authorization Form Patient Name: ___ Patient ID/SSN: ___ ___ ___ Exxon4375 Account #: ___ Job / P.O.#: ___Scheduler Name:___ Scheduler # : ___
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Who needs exxon-4375?

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Individuals who have earned income from ExxonMobil and need to report it for tax purposes.
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Employers who are required to provide this form to their employees for tax reporting.
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exxon-4375 is a form used for reporting certain tax information.
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