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RETURN THIS FORM - NC

ITEM 3: -0- -0- -0- $3,600.00 ITEM 4: $6,000.00 $6,000.00 $6,000.00 $2,400.00 ITEM 4: Subtract Item 3 from Item 2. THE RESULTS CANNOT BE A NEGATIVE AMOUNT. ITEM 5: Multiply Item 4 by the tax rate shown on the face of this report.

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