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Get Nyc Cs-1069 2010

Dress: _____________________________ RA Address: ___________________________ City, State & Zip Code: _____________________________________________________________ Att.: _________________________________ To be completed by employer’s personnel or payroll department: The above named individual is requesting/receiving publicly funded day care services. To make a financial eligibility determination, it is necessary to verify income for the last three(3) months. Please list overtime, if any, in the.

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