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W 588aa 2020
________________________
Settlement Amount:______________________________
Date of Incident:______________________
NYC File #(if action against NYC):_________________
Settlement Date:______________________
Index No.__________________________________
Case # or CIN:_______________________
Specify Injury: (E.G. Ankle Fracture), or Fax Bill of Particulars : _____________________________________
______________________________________________________________
Type of Lien (check one):
...
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