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Type or Legal Name Street or Other Mailing Address Street or Other Mailing Address City State ZIP Code City State ZIP Code Social Security Number Spouse’s Social Security Number Nebraska ID Number Federal ID Number
ContractNebraska Nonresident Income Tax Agreement • October 29th, 2010
Name Name Doing Business As (dba) Legal Name Street or Other Mailing Address Street or Other Mailing Address City, Town, or Post Office State Zip Code City, Town, or Post Office State Zip Code
