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Get It 214 Form 2011

Your last name ( for a joint claim, enter spouse s name on line below ) Your date of birth (MMDDYYYY) Your social security number Spouse s first name and middle initial Spouse s last name Spouse s social security number Spouse s date of birth (MMDDYYYY) Current mailing address ( number and street or rural route ) City, village, or post office Apartment number State ZIP code Country ( if not United States ) New York State county of residence You.

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