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Get PA PA-1000 2019

Cy. If incorrect, do not use the label. Complete Section I. Your Social Security Number Spouse s Social Security Number II Fill in only one oval in each If Spouse is Deceased, fill in the oval. PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE Last Name First Name MI 2. I Certify that as of Dec. 31, 2019, I am (a): A. Claimant age 65 or older B. Claimant under age 65, with a spouse age 65 or older who resided in the same household C. Widow or widower, age 50 to 64 D. Permanent.

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