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Get AR AR1000RC5 2015

I certify that the information listed above is true and correct. Initial Diagnosis Date Doctor or Examiner s Signature AR1000RC5 R 8/19/15 Date Street Address City Taxpayer s Signature State Zip. AR1000RC5 Click Here to Clear Form Info Click Here to Print Document ARKANSAS INDIVIDUAL INCOME TAX CERTIFICATE FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES Taxpayer s Name Taxpayer s Social Security Number Spouse s Name Spouse s Social Security Number This certificate must be completed in its entire.

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