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Get LA R-6642 2002

Ayer s Social Security Number I, hereby certify that I am the of the (Relationship or other capacity) deceased taxpayer and hereby make request for refund of the income taxes overpaid by or in behalf of the decedent. I, the undersigned claimant, certify, under all penalties, fines, and forfeitures imposed by law for the making of false or fraudulent claims against the State of Louisiana or the making of false statements in c.

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