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Get NY AC2709 2010

ON VERFICATION FOR PERIOD ENDED , 20 STATE OF INCORPORATION (name of business) DATE OF INCORPORATION (area or department, e.g., Corp Trust Division) ARE YOU AUTHORIZED TO DO BUSINESS IN NYS? (street address) FEDERAL EMPL. ID NO (street address) CONTACT PERSON (city, state, zip code) CONTACT TITLE CONTACT PHONE ( (service bureau, if used) CONTACT FAX ( (service bureau contact name) ) ) ADDRESS (service bureau contact phone) State of SS: County of EMAIL ADDRESS I certify that I am.

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