Form 12277 (Rev. October 2011)
schedules, exhibits, affidavits, and statements) and, to the best of my knowledge and belief, it is true, correct, and complete . Signature (Taxpayer or Representative) Title (if business) Date . Catalog Number 27939C www.irs.gov Form . 12277 (Rev. 10-2011) Page 2 of 2 . General Instructions . 1. Complete the application. ................
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