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P.O. Box 71107 Oakland, CA 94612 1.800.617.4729 1.888.270.4707 www.sterlingadministration.com COBRA QUALIFYING EVENT From This form is to be filled out by the employer or their representative and
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This form is to report income tax information.
Individuals and businesses with taxable income are required to file this form.
You can fill out this form online, or by mailing in a paper copy.
The purpose of this form is to report income and calculate taxes owed.
Income, deductions, credits, and taxes paid must be reported on this form.
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