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TO BE COMPLETED BY THE CENTRAL OFFICE This claim which exceeds 1 000 but is not more than 5 000 is approved by NYSDEC. I find that the facts constitute a just and legal claim against the State of New York as provided in paragraph 12 et seq. Subscribed and sworn to before me this CLAIMANT SIGNATURE day of in the year. The facts stated above must constitute a legal claim. NOTARY PUBLIC Small Claims 11/16 Page 1 of 2 RELEASE SECTION This release is not binding on the claimant until the claim is...
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