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EFTA00792171
dinary Dividends IP. Attach to Form 1040A or 1040. ► Go to www.Irs.gov/ScheduleB for instructions and the latest information. OMB No 15454/ 2017 AMOIrron: SQeu.enco No ANASTASIYA SIROOCHENKO Part I Interest Note: If you received a Form 10991NT, Form 1099O1D, or substitute statement from a br
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