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INFORMATION NEEDED TO COMPLETE FORM 2553
FOR S CORPORATION

Shareholder Information

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Address:



        



   City: State:   Zip:







Shareholder's Tax Year End: 



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   Name:  SSN:



Address:



        



   City: State:   Zip:







Shareholder's Tax Year End: 



   Month   Day 

---

   Name:  SSN:



Address:



        



   City: State:   Zip:







Shareholder's Tax Year End: 



  Month   Day 

---

   Name:  SSN:



Address:



        



   City: State:   Zip:







Shareholder's Tax Year End: 



  Month   Day 

---

   Name:  SSN:



Address:



        



   City: State:   Zip:







Shareholder's Tax Year End: 



  Month   Day 

---

   Name:  SSN:



Address:



        



   City: State:   Zip:







Shareholder's Tax Year End: 



  Month   Day 







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