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RETAIL FOOD ESTABLISHMENT INSPECTION REPORT124, 2L570 LA)3cS_state Form 48669 (R2/205) SDH Form 510001Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 724, Indiana

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Z-47401 5"1161"--4 is a tax form used in Delaware for the reporting of specific financial information by certain entities.

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