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(FOR OFFICE USE ONLY) INSTRUCTIONS: CIVIL COURT OF …

(FOR OFFICE USE ONLY) CIVIL COURT OF THE CITY OF NEW YORK SMALL CLAIMS PART STATEMENT OF CLAIM INSTRUCTIONS: Place only ONE letter or number in each space and leave a blank space between words. (Your) I. CLAIMANT'S INFORMATION LAST NAME FIRST NAME MIDDLE INITIAL BOROUGH, CITY, STATE ZIP TOWN OR VILL. OTHER INFO [Doing …

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