Get NY ES 161.5 2016-2021
and mail this form to the address above or fax it to (518) 402-6586. If you fax it, do not mail the original. If you need more space, attach additional sheets. Keep using certification coupons to claim weekly benefits until an SEAP staff member contacts you. You must report any days you work in employment or selfemployment when you claim weekly benefits. Name: Last four digits of Social Security Number: Telephone Number: 1. Why do you want to withdraw from the SEAP? Lack of money for busines.
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