N.Y. Comp. Codes R. & Regs. Tit. 21 LXXXIII app 25-A

APPLICATION FOR INFORMATION FROM CDTA AND ITS SUBSIDIARIES

PURSUANT TO SECTION 88 OF THE PUBLIC OFFICERS LAW

Request for Public Information

DATE:

Name:

Address:

Telephone Number:

Ogranization (if any):

Name of News Medium (if applicable):

Address of News Medium (if applicable):

Description of record to which access is requested or copy made available:

# of pages x $. $ ________

# of pages x $. $ ________

Total charge $ ________

Notes

N.Y. Comp. Codes R. & Regs. Tit. 21 LXXXIII app 25-A

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