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Get 1545-1813 ISSUER'S/PROVIDER'S Name, Street Address, City, State, ZIP Code, And Telephone No - Irs

Reproduction proofs. MUST be removed before printing. VOID Revised proofs requested CORRECTED ISSUER S/PROVIDER S name, street address, city, state, ZIP code, and telephone no. 1 Amount of HCTC advance payments OMB No. 1545-1813 $ 2006 2 No. of mos. HCTC advance payments received ISSUER S/PROVIDER S federal identification no. RECIPIENT S identification number RECIPIENT S name City, state, and ZIP code 9 $ 4 Feb. $ 10 Aug. $ 5 Mar. $ 11 Sept. $ 8 May $ 12 Oct.

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