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Authorized Person Designation/Notarized Sworn Statement Form Justice Center Criminal Background Check (CBC) Unit Fax: 5185490464 Email: cbc JusticeCenter.ny.gov REQUIRED Provider Name: Agency Code:.

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  1. Open the form in the feature-rich online editor by clicking on Get form.
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  5. Add the date.
  6. Check the entire template to be sure that you have not skipped anything.
  7. Hit Done and save the new form.

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