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05.05 N mero de Serie - Serial Number A o que comienza el de de y termina el de de Year beginning on of and ending on of R Liquidador N mero de Seguro Social o Identificaci n Patronal Social Security or Employer Identification Number Revisor Individuo Individual Corporaci n Corporation Nombre y direcci n del contribuyente - Taxpayer's name and address Sociedad Partnership Declaraci n Enmendada.

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