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Nitial Last name Permanent home address ( number and street or rural route ) City, village, or post office Apartment number State ZIP code Your social security number Single or Head of household Married Married, but withhold at higher single rate Note: If married but legally separated, mark an X in the Single or Head of household box. Are you a resident of New York City? .......... Yes No Are you a resident of Yonkers?..................... Yes No Comple.

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