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Ov/Form1065X for instructions and the latest information. (Enter month and year.) Employer identification number Name Please Type or Print OMB No. 1545-0123 For tax year ending Number, street, and room or suite no. (If a P.O. box, see instructions.) City or town, state, and ZIP code Telephone number (optional) Enter name and address used on original return (If same as above, write Same. ) Internal Revenue Service Center where original return was filed TEFRA/NonTEFRA Deter.
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