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PRINTED: 07/01/2022
FORM APPROVEDDivision of Health Service Regulation
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION NUMBER:MARACAS COTTAGE
(X4) ID
PREFIX
TAG.
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The 0105 form is an official document used for specific reporting purposes, typically related to taxation or regulatory compliance.
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Individuals or entities that meet certain criteria outlined by the governing authority are required to file the 0105 form.
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To fill out the 0105 form, follow the provided instructions carefully, entering all required information accurately in the designated fields.
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The purpose of the 0105 form is to collect essential information for compliance with regulatory requirements or taxation laws.
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The information required on the 0105 form may include personal details, financial data, and other relevant metrics as specified by the regulatory body.
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