Nexus Questionnaire - Montana Department Of Revenue Page 5

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Explain all "yes" answers in detail. Refer to questions answered by number. If the space provided is not sufficient, please
attach additional pages with references to applicable questions.
I declare under the penalties of perjury that I have examined this material and that the answers to the questions are to the
best of my knowledge and belief, true, correct, and complete.
Date
Signature of Officer
Title
Written Name

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