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Mineola, NY

25 Roslyn Road, 2nd Floor
Mineola, New York 11501
Map and Driving Directions

Phone: 516.PIATTYS
Phone: 516.742.8897

info@212answers.com

New York, NY

15 Maiden Lane, Suite 1400
New York, New York 10038
Map and Driving Directions

Phone: 212.ANSWERS
Phone: 212.267.9377

info@212answers.com

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Contact Information: Name:* Email:* Phone Number:* Alternate Phone Number: (Optional) Address: City: State: ZIP:

Injured Person Information: Date of Birth: Whom are you inquiring on behalf of? If you are NOT inquiring on your own behalf, what is your relationship? Is the person deceased? Yes No If deceased, the cause of death as stated on the death certificate: Was there an autopsy performed? Yes No Date of Death:

Injury/Case Information: Please describe your case and/or injury: Date of Incident:

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Mineola, NY

New York, NY

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