Tidewater Marketing Global Consultants, Inc.
Government Claim Form
Enter Information
Name (Individual / Company)
(required)
Contact Person (If Different)
Street Address
Mailing Adress (If Different)
City
(required)
State
(required)
Zip Code + 4
(required)
Taxpayer ID #
(required)
Telephone #
(required)
Cell Phone #
Facsimile #
Email
(valid email required)
Amount Claimed
(required)
Explain the basis for the amount claimed, including detailed computations, if any.
(required)
Other Information Deemed Pertinent
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Copyright (C) 2009 by Charles L. Stutts, Receiver