Form Exception To Determination Of Administrative Law Judge Page 2

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The Commissioners of the Tribunal are requested to make the following finding(s) of fact and/or conclusion(s)
of law (attach separate sheet, if necessary):
Check the appropriate box(es):
A supporting brief is attached hereto.
I I
A supporting brief will be submitted within 45 days of the filing of this Exception.
I I
No brief will be submitted in support of this Exception.
I I
An opportunity for oral argument is requested.
I I
WHEREFORE, the party taking exception respectfully requests that the above-referenced Determination be re-
versed or modified on the foregoing grounds. The statements herein are made with the knowledge that a willfully
false representation is a misdemeanor punishable under section 210.45 of the Penal Law of the State of New York.
_______________________________________________
____________________________
Signature of Party/Representative* L
Date L
*If this Exception is signed by a Representative of the party taking exception, attach a duly executed power of attorney.
TAT-EXC

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