PUBLIC HEARING REPLY FORM
Persons wishing to present testimony at the public hearing on congressional and state legislative redistricting are requested to complete this reply form as soon as possible and mail or fax to:
The New York State Legislative Task Force on
Demographic Research & Reapportionment
250 Broadway, 21st Floor
New York, New York 10007-2563
Phone: (212) 618-1100
Fax: (212) 618-1135
E-mail: info@latfor.state.ny.us
Website: www.latfor.state.ny.us
I plan to make a public statement at the January 30, 2012 - ALBANY Hearing
I will limit my statement to five (5) minutes, and will provide 10 copies of my statement I will be prepared to answer any questions.
I will require assistance and/or handicapped accessibility information.
Please specify the type of assistance required:
Please specify the type of assistance required:
___________________________________________________________________________________
___________________________________________________________________________________
NAME:
___________________________________________________________________
TITLE:
___________________________________________________________________
ORGANIZATION:
___________________________________________________________________
ADDRESS:
___________________________________________________________________
E-MAIL:
___________________________________________________________________
TELEPHONE:
___________________________________________________________________
FAX TELEPHONE:
___________________________________________________________________