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NEW YORK STATE
Paper prior approval request forms, with appropriate attachments, should be sent to: eMedNY, PO Box 4600, Rensselaer, NY 12144-4600. A supply of the new Prior
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RECEIPT FOR RENT MONEY
RECEIPT FOR RENT MONEY. On JJJJJJJJJJJJJJJJJJJJJJ (date), JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ (tenant name) paid $JJJJJJJJJJJJJJJJJJJJJJJJ in: G CASH. G CHECK
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PA Rent Certificate and Rental Occupancy Affidavit
If your landlord, or your landlords authorized agent, does not sign this PA Rent Certificate, you must complete Lines 1 through 8 and the Rental Occupancy
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