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, IT 205, ST-140, or ST-141. (See instructions on back for assistance in completing this form.) Name as shown on personal income tax return or sales and use tax return Social security or employer identification number Spouse s name as shown on personal income tax return, if applicable Spouse s social security number Complete this form if you are reporting sales or use tax liability on your personal income tax return or your individual purchaser s annual or periodic report of sales an.

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