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PRINTED: 04/17/2023 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:THE LANDINGS CABARRUS (X4)
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The printed 0417 form is an official document used to report specific information required by government regulations, typically related to tax, financial transactions, or compliance.
Entities or individuals that meet the specified criteria set forth by the governing authority are required to file the printed 0417 form, generally related to income, expenditures, or particular activities outlined in the regulations.
To fill out the printed 0417 form, follow the provided instructions, ensuring to complete all required fields accurately, provide supporting documentation if necessary, and sign the form before submission.
The purpose of the printed 0417 form is to collect specific information from taxpayers or organizations for compliance and reporting purposes, facilitating the assessment of taxes or adherence to regulations.
The printed 0417 form must typically report financial information, including income, expenses, identification details of the filer, and any other pertinent data specified in the form's instructions.
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