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Get It 258 Form 2022-2024

(s) as shown on return Your Social Security number Part 1 Nursing home information (must be located in New York State) New York State residential health care facility Address (number and street) City State ZIP code NY Resident s name (if different from the taxpayer claiming the credit) Resident s Social Security number Part 2 Credit amount 1 Enter the 6% base-rate portion of the assessment imposed on a New York residential health care facility and paid directly by you d.

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