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Rity number Present address (Number and street) City or town State ZIP code Maryland county Daytime telephone number City, town or taxing area Name of County in which you were a resident on the last day of the tax year. (Baltimore City residents leave blank) Name of incorporated city, town, or special taxing area in which you were a resident on the last day of the tax year. THIS IS A LIMITED USE FORM. PLEASE SEE INSTRUCTIONS. If you are amending for an earned income credit, refundable.

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