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Get OR OR-PS 2019

Photocopy Taxpayer s first name Taxpayer s last name Spouse s first name Spouse s last name Tax year Letter ID Provider s full name Provider s Social Security number (SSN), or federal employer identification number (FEIN) Part 1: Dependents. Complete this section for care you provided to the dependents of the taxpayer(s) during the tax year above. Third party payments are payments made from other sources than the taxpayer(s), including payments from Department.

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