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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:

Division/Bureau:

1. Name of individual appearing:

Address:

Telephone:

2. Client represented:

Address:

Telephone:

3. Subject of Appearance:

Regulatory/Enforcement
Lobbying

4. Acting in capacity of:
Attorney
Lobbyist
Agent
Other (describe)

5. Are you being compensated?
Yes
No

If Yes:
Fee
Salary

6. Signature of individual appearing: __________________________________________

7. Agency official (type name):

8. Signature of agency official: __________________________________________

*A LOBBYIST is a person or organization, other than a New York State government employee acting in an official capacity, who appears for the purpose of influencing the adoption or rejection of proposed rules, regulations, rates, legislation, including the State budget or the specification or award of a State Procurement Contract. An "appearance" for lobbying purposes can be a personal visit, letter, telephone call, conversation at a meeting, or any other type of contact, but does not include "on the record" proceedings or hearings.