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STATE OF OREGON STATE DEPARTMENT OF GEOLOGY AND MINERAL INDUSTRY 239 SOUTHEAST H STREET P. 0. BOX 417GRANTS PASS. OREGONDOUBLB IJACK 1111 Au,A&,......9!!9!::operaton: ...,:,:.A!1.I )A8h2nd JaoblolaOrin

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OT U 11FT 14 is a tax form used for reporting specific financial information to the relevant tax authority.

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