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Complete this part only if you are filing Form 8379 by itself and not with your tax return. Under penalties of perjury I declare that I have examined this form and any accompanying schedules or statements and to the best of my knowledge and belief they are true correct and complete. Address For Privacy Act and Paperwork Reduction Act Notice see page 3. City State Cat. No. 62474Q ZIP code Rev. 12-2008 Form 8379 Rev. 12-2008 Page Allocated Items Al.

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