Nexus Questionnaire - Maine Revenue Services Page 8
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8______________
Date
Signature of Corporate Officer, Partner or Owner
Title
_______________________________________________________
Please Print Name of Above Signer
OR
I declare that, although I am not an officer of the corporation, I have prepared this re-
port upon the basis of all information of which I have knowledge.
Date
Signature
Title
Phone #
Revised 09/11
8
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