PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on the impact of funding in the SFY 2010-11 budget on the administration of elections in New York State in compliance with the federal Help America Vote Act and issues arising out of such compliance are requested to complete this reply form as soon as possible and mail, e-mail or fax it to:

Laurie Barone, Senior Analyst
Assembly Committee on Election Law
Alfred E. Smith Bldg., Suite 1147
80 So. Swan Street
Albany, New York 12248
E-mail: baronel@assembly.state.ny.us
Phone: (518) 455-4313
Fax: (518) 455-3669
box
I plan to attend the public hearing on the impact of funding in the SFY 2010-11 budget on the administration of elections in New York State in compliance with the federal Help America Vote Act and issues arising out of such compliance to be conducted by the Assembly Committee on Election Law and the Assembly Subcommittee on Election Day Operations and Voter Disenfranchisement on December 10, 2010.
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: