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Fiscal year beginning OMB No. 1545-0092 , 2003, and ending Name of estate or trust (If a grantor type trust, see page 12 of the instructions.) , 20 C Employer identification number D Date entity created E Nonexempt charitable and splitinterest trusts, check applicable boxes (see page 13 of the instructions): Simple trust Complex trust Qualified disability trust Name and title of fiduciary ESBT (S portion only) Grantor type trust Number, street, and room or suite no. (If a P.O. box.

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