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A B C D E F G H I 1 J K L M Date: Sample Form Developed by the Dormitory Authority of the State of New York modified by mob 2 3 4 SCHEDULE OF VALUES 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
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Sample form is developed by the regulatory agency.
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All businesses operating in the regulated industry are required to file the sample form.
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