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Internal Revenue Service Please Type or Print For tax year beginning , 19 , and ending , 19 Name of fund . Employer identification number of fund (see instructions) Number, street, and room or suite no. (If a P.O. box, see instructions.) City or town, state, and ZIP code Name and address of administrator (see instructions) Check applicable boxes: Income 7 8 9 10 11 12 13 14 Final return (2) Change of address 15 16 (3) Amended return 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Trustee/.

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