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Check here if you have no new Medicaid-eligible residents who have received a custom or non-custom Resident Name Resident Identification Number Signature of Authorized Facility Representative Date Fax the form to 217-524-7114 or mail to Bureau of Long Term Care 201 South Grand Avenue East Springfield IL 62763 Print Form HFS 1463 N-6-10 Custom Motorized Wheelchair Non-Custom.
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What is form 1463?
Form 1463 is a form used for reporting certain financial transactions to the government.
Who is required to file form 1463?
Certain individuals and entities that have engaged in specified financial transactions are required to file form 1463.
How to fill out form 1463?
You can fill out form 1463 by providing the requested information in each section of the form, such as personal details, transaction details, and any supporting documentation.
What is the purpose of form 1463?
The purpose of form 1463 is to ensure transparency and compliance with financial regulations by reporting certain transactions to the relevant authorities.
What information must be reported on form 1463?
Form 1463 requires information such as the nature of the transaction, the parties involved, the amount of money or assets involved, and any additional relevant details.
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