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THISFORMMUSTBEPRINTEDDOUBLESIDEDpage1of2 MEDICALFORM Name Address City State Zip Phone: Work Phone: Email: Do you want to be on our news list? Y / N Occupation Company Name Date of Birth Sex Height
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This form is a tax form.
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Individuals, businesses, or entities who meet certain criteria set by the tax authorities.
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The purpose of this form is to report income, expenses, and other relevant financial information to the tax authorities for tax assessment.
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