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Get For Office Use Only Attach Label, Or Print Or Type New York State Department Of Taxation And

Your social security number(s) in the boxes to the right. Your first name and middle initial Your last name (for a joint claim, enter spouse s name on line below) Your social security number Spouse s first name and middle initial Spouse s last name Spouse s social security number Mailing address (number and street or rural route) City, village or post office Apartment number State ZIP code NY State county of residence Qualifying social security number if different fr.

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