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PRINTED: 04/10/2019
FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION
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Holly Manor - Virginia is a state tax form for reporting income and expenses related to properties in the state of Virginia.
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Individuals who own property in Virginia and have rental income or expenses related to that property are required to file Holly Manor - Virginia.
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Taxpayers must report details of their rental property, rental income received, expenses incurred, and ownership information on Holly Manor - Virginia.
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