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Get IRS Form 14764 2018-2024

Ide Your Contact Information Name Address (if you changed your address, make the changes below) City State Country Primary telephone number Best time to call Secondary telephone number Best time to call Zip code Indicate Your Agreement or Disagreement Agreement with proposed assessment I consent to the assessment and collection of the proposed assessment of the ESRP in the amount of $0.00 Signature Date Print name and title of the person who signed above Partial/Total disagreement.

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