PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Homeless Services in New York State are requested to complete this reply form as soon as possible and mail, email or fax it to:

Jennifer Marrero
Legislative Analyst
Assembly Committee on Social Services
Room 422 - Capitol
Albany, New York 12248
Email: marreroj@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
box
I plan to attend the following public hearing on Homeless Services to be conducted by the Assembly Committees on Social Services and Oversight, Analysis, and Investigation on December 9, 2014.
box
I plan to make a public statement at the hearing. My statement will be limited to 10 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.
box
I will address my remarks to the following subjects:


box
I do not plan to attend the above hearing.
box
I would like to be added to the Committees' mailing list for notices and reports.
box
I would like to be removed from the Committees' mailing list.
box
I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:


NAME:

TITLE:

ORGANIZATION:

ADDRESS:

E-MAIL:

TELEPHONE:

FAX TELEPHONE: