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Supply ID Cashline # Amount $ m m d d y y y y NY Received by Improperly completed forms or improperly calculated fees will be returned and may delay processing of your plans. Instructions to operator for completion of this form: To determine what fee applies to your operation: A. Exempt - no fee B. All others A. Exemption Request B. Locate category type of your establishment on the list below (e.g., food service, temporary residence). 1. Is this facility operated by a religious, ed.

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