•
6971
REQUIRO SCIENTIA LIC Frcr»THIRD BANK
PALM BEAD', FL 33190 634171470
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PAY TO THE
ORDER OF Kantac Inrama Tay $ —1.000.co
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Kansas Income Tax/ Kansas Dept of Revenue
915 SW Harrison
Topeka, KS 6699-1588
d/AE.10
Form K-40 EIN 264205220
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EFTA00272555
1S1012116/1 13110'1
NIg$110.11.446"
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MY 102
1000 FOR DEPOSIT ONLY 011512759884
9581 KANSAS DEPT OF REVENUE/SRS
EFTA00272556