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6100 RED HOOK QUARTER, B3 NEW YORK, NEW YORK 10154 0)
ST. THOMAS 00802 1.103/210 2/7/2018
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PAY TO THE
ORDER OF New York State Insurance Fund $ "1,850.92
One Thousand Eight Hundred Fifty and 92/100***********"*********"********""***** *********""*" *********-***** DOLLARS
The State Insurance Fund
Workers' Compensation 8
P. O. Box 5238
New York, NY 10008-5238
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