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Get and Sign 1099 Hc Form 2015
Birth
Mar.
Apr.
May
June
Corrected:
July
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Dec.
July
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July
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Subscriber number
Full-year minimum creditable coverage? If No, check months with minimum creditable coverage:
Yes
No
b. Name of dependent
Jan.
Feb.
Date of birth
Mar.
Apr.
May
June
Corrected:
Subscriber number
Full-year...
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