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Trator. Complete this form and e-mail a scanned copy of this form to DOI.TPA doi.idaho.gov by 7/1/2011. TPA Information Name of TPA FEIN Idaho TPA License # Address 1 Address 2 City State State of Domicile Annual Report for the fiscal year ending ZIP TPA Home State The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the.

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