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Get Ny Nyc-1127 2012

Initials of employee and spouse: Last name: Home address (number and street): Apt. no.: City and State: Zip Code: NYC Department or Employee Agency where employed: Spouse A. A. MARRIED FILING JOINTLY B. OR SURVIVING SPOUSE TAXPAYER S EMAIL ADDRESS SPOUSE S SOCIAL SECURITY NUMBER HEAD OF C. HOUSEHOLD A. NUMBER OF MONTHS EMPLOYED IN 2012 ...... EMPLOYEE: B. DATE RETIRED FROM NYC SERVICE ................ EMPLOYE.

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