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Get Nys Form Doh 4425

Audit Report Exemption Form NEW YORK STATE DEPARTMENT OF HEALTH Audit Services Clearinghouse Instructions Complete and email to address below. Organization NAME FEIN NYS VENDOR ID FISCAL YEAR END DATE / MM CITY STATE TELEPHONE ZIP FAX - DD YYYY TITLE TOTAL FEDERAL FUNDED EXPENDITURES CONTACT EMAIL DATE CONTACT NAME STREET ADDRESS TOTAL NYSDOH FUNDING received Certification For the indicated fiscal year the above-named organization including any p.

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