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Get NY 104 2011-2024

D, give Certificate No. 30 and State Signature of Driver (or Representative*) of Vehicle 1 Print Name of Driver (or Representative*) of Vehicle 1 A representative may sign for the driver if the driver is unable to sign because of injury or death. If you are signing as the driver’s representative, check the box that describes why the driver cannot sign. * 3 Sex 4 City or Town Damaged Property ‘ IdentifyThan Vehicle(s) Other Date 2 Apt. Number Address (Include Number & Street) Ci.

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