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PRINTED: 10/14/2019 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:A. BUILDING: ___ B. WING ___MHL011390
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Form 10319 is used to report certain financial transactions to the IRS.
Any individual or entity that engages in reportable financial transactions is required to file Form 10319.
Form 10319 can be filled out electronically or by hand. The form requires information such as the type of transaction, the date of the transaction, and the amount of the transaction.
The purpose of Form 10319 is to provide the IRS with information about certain financial transactions that may be relevant for tax purposes.
Information such as the type of transaction, the date of the transaction, and the amount of the transaction must be reported on Form 10319.
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