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PRINTED: 03/02/2024 FORM APPROVED Indiana State Department of HealthSTATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: 230053941(X2) MULTIPLE CONSTRUCTION(X3)

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Obtain the 03022024 form from the Indiana State Department.

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The 0302 form is a tax document used by the Indiana State Department of Revenue for compliance and reporting purposes, typically related to specific tax liabilities or statuses.

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The purpose of the 0302 form is to report income, tax liabilities, and other relevant financial information to ensure compliance with Indiana tax laws.

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Information required on the 0302 form includes personal identification details, income amounts, tax deductions, applicable credits, and any other specified financial data as outlined in the instructions.

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