Form 480.70(Oe) - Informative Return For Income Tax Exempt Organizations July 2008 Page 4

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Rev. 07.08
Form 480.70(OE) - Page 4
Part VI
Compensation in Excess of $5,000 Paid to Independent Contractors for Professional Services
Social security or employer
Name and address
Type of service
Compensation
identification number
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OATH
I hereby declare under penalty of perjury that this return (including the schedules and statements attached) has been examined by me, and to the best of my
knowledge and belief it is true, correct and complete.
CORPORATE
Title
Official's signature
SEAL
Date
For Specialist's Use Only
I hereby declare under penalty of perjury that this return (including the schedules and statements attached) has been examined by me, and to the best of my
knowledge and belief, the facts in the same are true, correct and they constitute as a whole, an exact and complete return. The declaration of the person that
prepares this return is with respect to the information received and this information may be verified.
Specialist's name (Print)
Registration number
Check if self - employed
specialist
Firm's name
Employer identification number
Specialist's signature
Date
Day _________ Month ________ Year ________
Address
Zip Code
NOTE TO TAXPAYER
Indicate if you made payments for the preparation of your return:
Yes
No. If you answered "Yes", require the Specialist's signature and registration number.
Retention Period: Ten (10) years

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