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EFTA02672785
em or service, attach a list showing the information requested on lines 1 through 12 for each item or service. 1 Item purchased or service rendered lj furniture 0 furs ❑jewelry El utility gas 0 other and electricity (dentify) 1/4 interest art work 2 Date brought into New York State Jul. 11, 2OOO (see inst
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