LIC34: Licensing Supplemental Affidavit - New York City

LIC34: Licensing Supplemental Affidavit Application must be typewritten. 1 Convictions Date of Conviction Charge or Offense Name of Court and Location Sentence or Disposition If you have been convicted of an offense, explain fully in the boxes below. 2 Penalties and Fines 3 Statements and Signatures (*Indicates optional)

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