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Get SSA-820-BK 2012

Y benefits. What You Need To Do Please complete and return the completed form within 15 days to the address shown above. It is important to fill out the form carefully and completely. Remember to sign and date the form. If you do not return this form, we may make our determination based on the evidence we have in our records. Some Information To Help You Complete This Form Our records show the following self-employment income for you. This list may not be complete. It may not show your work for .

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