STATE OF NEW YORK Notice of Appearance

Section 166 of the Executive Law requires a regulatory agency to maintain for public inspection, a record of who appears before it, for a fee as a third party (i.e., an attorney, agent, lobbyist*, or representative) on behalf of a person or organization subject to the regulatory jurisdiction of the agency. This usually occurs when the third party's client is involved in an enforcement, formal permit, or application matter. This form is subject to all the rules and regulations of the Freedom of Information Law. Information that is confidential as a matter of law need not be furnished.

This form is to be completed by any person appearing before the regulatory agency in such a representative capacity, and given to the agency staff person before whom he/she is appearing for signature.

Agency: Agriculture & Markets Banking Education Energy Research & Development Environmental Conservation Health Housing & Community Renewal Insurance Labor (Industrial Board of Appeals) Law (Attorney General) Liquor Authority Mental Health Mental Retardation & Developmental Disabilities Motor Vehicles Parks, Recreation & Historic Preservation Public Service Commission Real Property Services State Department Temporary & Disabilities Assistance

Division/Bureau:

1. Name of individual appearing:

Address:

Telephone:

2. Client represented:

Address:

Telephone:

3. Subject of Appearance:

Regulatory/Enforcement
Lobbying