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Ng or transacting business in Westchester County, pursuant to Section 130 of the New York State General Business Law, under the name or designation (Please Print or Type) and at the address of: Business Name: Business Address: My full name and place of residence is: (Please Print or Type) Name: Address: I FURTHER CERTIFY that I am successor in interest to . (Name of former owner of business, if applicable.) I FURTHER CERTIFY that I am.
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