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Get NY W-147N 2016-2024

of the premises described on page 1 of this form, certify that tenant/participant name has vacated the apartment located at Apt. on or about address and occupied the date apartment within three months prior to the date of this certification. I hereby request that the security voucher be paid to me for the reason specified below: Tenant/Participant defaulted on payment of rent for judgment, stipulation, landlord breakdown, etc). (provide court Month/Year Tenant/Participant caused the fol.

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