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ROY COOPER Governor KODY H. KINSLEY Secretary JAY LUDLAM Deputy Secretary, NC MedicaidDate: Providers Name: NPI #: Address: City, State & Zip Code: Is Request Disaster Related (Yes/No) The North Carolina

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Form 1040

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All individual taxpayers in the United States

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The purpose of Form 1040 is to report an individual's annual income and calculate the tax owed to the federal government.

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Taxpayer's personal information, sources of income, adjustments to income, deductions, and tax credits.

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