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Get NY DepCertApp 2012

Or, New York, NY 10038 Instructions: Please complete, notarize and mail this application to the address above. See General Instructions on page 4. Certificate Date:_____/_____/_____ OFFICE USE ONLY - DO NOT WRITE IN THIS BOX Certificate Number:_______________ Account Number:_______________ SECTION A. COURT AND CASE INFORMATION Amount: $______________ 1. Name of Court _____________________________________ 2. County of Court ____________________________________ 3. Index no.:_____________.

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