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S and judgements) a b c d e f g h 26 Federal taxes owed (prior years) 27 Total $ $ (f) Name and Address of Lien/Note Holder/Obligee (g) Date Pledged (h) Date of Final Pymt. Section III Income and Expense Analysis The following information applies to income and expenses during the period to Accounting method used Income 28 Gross receipts from sales, services, etc. Expenses $ 34 Materials purchased 29 Gross rental income (Number of employees .) 35 Net wages and salaries.

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