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New York State Thruway Authority Office of Traffic Management P. O. Box 189 Albany NY 12201-0189 518 471-4440 TA-W6839 01/2012 Clear Form REPORT OF ASSISTANCE BY FIRE DEPARTMENT Purpose This form is completed by the attending Fire Department within 90 days from the date of service only if expenses for this call have not been submitted to and/or paid by other means including an insurance claim. Resulting donations intend to defray but not necessar.

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