File:NYCRR 19391112 Form1001.png
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![File:NYCRR 19391112 Form1001.png](https://upload.wikimedia.org/wikipedia/commons/thumb/4/4e/NYCRR_19391112_Form1001.png/525px-NYCRR_19391112_Form1001.png?20150503024409)
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Original file (1,200 × 1,371 pixels, file size: 1.42 MB, MIME type: image/png)