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Get NY W-146E LLF 2007

Form W-146E LLF Rev. 5/24/07 Date Case Number Case Name Request to Pay Rent Arrears in Excess of Public Assistance Maximum Shelter Allowance I am requesting assistance to pay rent arrears to avoid eviction. Name I understand that my rent is in excess of the public assistance maximum shelter allowance for my household size. payments will be made including a statement from a third party that will help me pay my rent. If any of the rent arrears advanced to me duplicates assistance previously given .

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