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EFTA00595680
1 Email address Fax number 1 Employer Identification number 45-6341048 2 Social secunty number 3 Total number of forms 1 4 Federal income tax vAthheld $ 5 Total amount mooned with this Form 1096 $ 464294 6 Enter an "A" in only one box below to indicate the type of form being Ned. 7 II this is
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