the New York Department of Labor does not offer this form in my primary language. Employee Signature Date Preparer Name and Title r: nut ,,,,,,,AONFJPFATIOJAn. Minalenvni F1, 01.1 •P/Den *Owe. Co Criwirtmt Aerkurmin.m it:fray...von% S'kft•wrt Lantoot. Seat I tva Stionn Kasen Rawer Ninth Macy Rerhoat :~~••