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Al Registration Number Street Address (As on file with the Comptroller of Maryland.) City State ZIP Code +4 Contact name Phone number Email address PART II - REPORTING AGENT: Legal Name Taxpayer Identification Number DBA Name PTIN Street Address City State Contact name Phone number Fax number ZIP Code +4 Email address Reporting Agent, named above, is authorized to discuss and/or request as a designee of the Taxpayer to receive copies of notices, correspondence, transcripts, d.
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