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PRINTED: 06/14/2018 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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The printed 0614 form approved is a specific tax form used for reporting certain financial activities to the tax authorities, ensuring compliance with tax regulations.
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