Application For A Combined Craft Manufacturing License For Existing Licensed Craft Manufacturers - New York State Liquor Authority Page 3

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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, 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:

NYS Liquor Authority / Division of Alcoholic Beverage Control

Division / Bureau:

Licensing

1. Name of individual appearing:

Address:

Telephone:

e-Mail:

2. Client represented:

Address:

Telephone:

3. Subject of appearance:

Regulatory / Enforcement

Lobbying

Attorney

Agent

Other (describe below)

4. Acting in the capacity of:

Lobbyist

Description:

Yes

5. Are you being compensated:

If YES, Check FEE or SALARY:

SALARY

FEE

6. Signature of individual appearing:_________________________________________________________

_______________________________________________________________________________________________

7. Agency official (printed 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, 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.

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