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Dr. Gholam R. Mohammadzadeh, M.D. 77 Rolling Oaks Drive Suite 202 Thousand Oaks, CA 91361 Phone (805) 3796717 Fax (805) 3796719PATIENT REGISTRATION INFORMATION NAME: ___DATE OF BIRTH: ___ ADDRESS:

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Gholam Gary R. Mohammadzadeh is a tax form used for reporting foreign assets.

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U.S. citizens, resident aliens, and certain non-resident aliens with specific financial interests in foreign countries are required to file Gholam Gary R. Mohammadzadeh.

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The form must be completed accurately and include all required information regarding foreign assets.

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The purpose of Gholam Gary R. Mohammadzadeh is to report foreign financial accounts and assets to the U.S. government.

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Information such as the maximum value of the foreign financial account, the account number, and the foreign financial institution's name and address must be reported on Gholam Gary R. Mohammadzadeh.

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