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Get PR 481.10 2013

E NOT BEEN CLAIMED AS A DEPENDENT IN ANY INCOME TAX RETURN FOR THIS TAXABLE YEAR. I hereby declare under penalty of perjury that this return, has been examined by me and it is true, correct and complete. The declaration of the person that prepares this return (except the taxpayer) is based on the information availabe, and this information has been verified. Taxpayer's Signature Date 04 Specialist's Name (Print) Specialist's Signature Spouse's Signature Date x x Name of the Firm or Busine.

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