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TIER 3 & 4 REVISED LOAN APPLICATION RS 5025-A Receipt Date Mail completed form to: NEW YORK STATE AND LOCAL RETIREMENT SYSTEM 110 STATE STREET MAIL DROP 5-9 ALBANY NY 12244-0001 Office Use Only (Rev.
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Begin by typing or writing the name of the individual or entity for whom the form is being filled out. This could be the name of a company, an individual, or an organization.
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Now, enter the case number related to the form. This number could be obtained from any previous communication or documentation provided by the court or relevant authority.
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Fill in the names of the parties involved in the case. Include the full names of all individuals or entities involved, such as the plaintiff and the defendant.
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Indicate the date on which the case was filed. This date is important for record-keeping purposes and helps provide context to the form.
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Provide a brief summary of the reason for filing the form. This should give a clear and concise explanation of the issue or dispute being addressed by the form.
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In the designated section, write out the monetary amount being claimed or sought as a result of the case.
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