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6100 RED HOOK cum rEn. 83 NEW YORK. NEW YORK 10154
ST. THOMAS 00802 1-103-210 5/26/2015
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PAY TO THE
ORDER OF New York State Insurance Fund $ "10,906.15
Ten Thousand Nine Hundred Six and 15/100 1
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The State Insurance Fund
Workers' Compensation 8
P. O. Box 5238
Binghamton, NY 10008-5238
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