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Get NY RET-54 2015

R – Instructions: Print clearly in ink or type the requested information in the areas provided. Write your EmplID or Social Security number in the boxes above and on pages 2, 3 and 4. Your signature on page 4 must be notarized or the application will be invalid. Review the information you have entered and the checklist on page 8 before sending your application to the System. To make a change, draw a single line through the incorrect information, enter the updated information, and initial you.

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