Notice Of Appearance Form - State Of New York
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1STATE 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, an 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.
Agency: __________________________________________Date:____________
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 (print name):____________________________________
Signature:________________________________________________
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, rate or legislation, including the State budget. An “appearance” for lobbying purposed 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.
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