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Get Child Care Expenses Receipt/Affidavit For Income Tax Purposes_DSA

Ld or Children to These child care fees were paid for the period of Month/Day Information about the person or company issuing this receipt/affidavit . Month/Day Year (required by the Internal Revenue Service): Child Care Provider's Printed Name: Address: Telephone No.: ( ) Provider Tax Identification No.: EIN/SSN I as the child care provider do declare, under the penalties of perjury, that the foregoing attestations are true and correct to the best of my knowledge and belief. Declarer'.

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