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6100 RED HOOK QUARTER, 83 0,
NEW YORK, NEW YORK 10154
ST. THOMAS 00802
1.1031210 11/16/2016
PAY TO THE
ORDER OF New York State Insurance Fund "11,574.56
Eleven Thousand Five Hundred Seventy-Four and 56/100
_DOLLARS
The State Insurance Fund
Workers' Compensation 8
P. O. Box 5238
Binghamton, NY 10008-5238
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