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Get Where I Do I Fill Out A Request To Louisiana Department Of Health And Hosiptal For Help Dealingwith

S ign and d a t e t h i s f o r m . Name Social Security Number If joint return. Spouse s Name Spouse s Social Security Number Address LA Revenue Account Number City State ZIP Federal Employer ID Number Daytime Telephone Number ( ) 2. Appointee If yo u want t o nam e m or e t han one a p p o i n t e e , a t t a c h a l i s t t o t h i s f o r m . Name Telephone Number ( Address ) Fax Number ( City State 3. Tax Matters a Tax Type ZIP ) E-mail Address T h e.

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