Mailing Address (Required — Network — Epstein Files

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Mailing Address (Required — Network — Epstein Files

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Mailing Address (Required

MAIL & FAX YOUR TAX CLEARANCE APPLICATION

License Renewal 6

I. Name

Philadelphia

Please Print

Daytime

United States Federal Government

the Internal Revenue Service

Agency Requiring Report

Social Security Number

Line 2 - Tax Identification Number:

the Social Security Administration

IRS

Physical Address

Agency

Lottery Dealer

SSN

John Smith

Federal Income Tax Returns

ST THOMAS

Virgin Islands Bureau of Internal Revenue

DBA Smith's Construction

the Virgin Islands Bureau of Internal Revenue

PROFESSIONAL LICENSURE & HEALTH PLANNING VI DEPT

U.S.

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