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Get NY DOH-299 1999-2024

Umber Place of Death State Number of I, (name of applicant) (address of applicant) request that the following information amend the certificate of death identified above: ITEM IN ERROR (or omitted) AS IT APPEARS AS IT SHOULD BE Documentary evidence submitted herewith in support of this application includes: Explain reason for error or omission: Under the penalties of pe~ury, I hereby affirmthat the statements made herein are true and correct to the best of my knowledge. Signature of A.

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