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Get Fs 100 Application 2010-2024

E of Applicant (as will appear on insurance ID cards and registration) Check One: ORIGINAL APPLICATION RENEWAL Mailing Address (No. & Street) City State Phone Fax 1. Are you currently self-insured in New York State? ZIP Code Federal Employer Number E-Mail Yes No If yes, give certificate number 2. If approved, please indicate the number of vehicles you expect to register in New York State under your self-insurance certification. In ad.

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