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Get NY FT 946/1046 2006

Mber x $.064 $ Line 10 gallons x $.08 $ ( ) Telephone number Street address For office use only ZIP code Federal employer identification number (FEIN) Total refunds $ Audited by: Date: Approved by: Date: Approved by: Date: Refund claimed Enter total refund claimed (from line 13 on back) ..................................................................................................................... $ Mark an X in this box if yo.

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