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Get RI DoR T-79 2016-2021

(domicile) at time of death ("late of") Decedent's social security number Date of Death: Address 2 City, town or post office State 1 Has Form 100 or Form 100A been filed? .................................................. 1 2 Number of shares or face amount of bond ................................................ 2 3 Name of Company 4 Held in the name of ........................................... 4 ZIP code Yes No ........................................... 3 A SEPARATE APP.

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