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Get Massachusetts Form 1099 Hc

Inistrator 3. Name of subscriber 4. Date of birth 5. Subscriber number 6. Street address 7. City/Town 8. State 9. Zip Full-year minimum creditable coverage? If No, indicate months with minimum creditable coverage: Yes No a. Name of dependent Date of birth Subscriber number Full-year minimum creditable coverage? If No, indicate months with minimum creditable coverage: Yes No b. Name of dependent c. Name of dependent Date of birth S.

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