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Taxpayer s name Social Security Number or Connecticut Tax Registration Number Spouse s name if joint liability Spouse s Social Security Number Mailing address City state and ZIP code Physical address number and street if different from above Daytime telephone number Case Identification Number Notice Number Tax type s For the period s Name of authorized representative Attach a copy of Form LGL-001. Email address of representative Basis for Protest As required by law you must provide a written ex ...

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