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Get NY NYSLRS RS 5025-A 2009

Ly (Rev. 6/09) Please see pages 3 and 4 for instructions on completing this form. We cannot accept faxed loan applications. If you are not sure you are eligible for a loan, please call us toll-free at (866) 805-0990 or (518) 474-7736 in the Albany, New York area. You must answer all questions in ink and the application must be signed and notarized, or it will be rejected. 1 Personal Information A. Social Security Number - Registration Number (if known) - - Last Name First Name M.I. P.

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