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IMPORTANT DO NOT SIGN THIS FORM UNTIL YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE. APPLICANT S REPRESENTATIVE Sign Here Print Your Name Identification No. from your Driver License Permit or Non-Driver ID Card Print Your Facility s Name Facility s Phone No. Facility s Mailing Address APPLICANT Sign Here OFFICE USE ONLY Proofs of Identify Presented by Representative all are required o NYS Photo Driver License/Permit/Non-Driver ID o Government or G...
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