Account Information
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Location Address
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Business Name
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New mailing address - if applicable
Gross Receipts
SELECT MONTH ENDING
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Gross receipts
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Exclusions
Your Contact Information
Name
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Title
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Phone #
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Email Address
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I certify that this return, including the accompanying schedules or statements, has been examined by me and is, to the best of my knowledge and belief, a true and complete return made in good faith for the period stated.
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