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PRINTED: 06/23/2022 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:MANI RESIDENTIAL/HUMAN SERVICES,
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Printed 0623 form approved is a tax form used to report certain tax information to the IRS.
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The purpose of the form is to report specific tax-related information to the IRS.
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