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(FOR OFFICE USE ONLY) INSTRUCTIONS: CIVIL COURT OF THE ...
last name first name middle initial borough, city, state zip town or vill. other info [doing business as] [in care of] [attention to] circle one phone no. cert'd # (their) ii. defendant's information* last name (or full business name) coa code first name middle initial claim amt. $ borough city, state zip fee town or vill. standard fee other ...
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