PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on the establishment of statewide goals and objectives; statewide comprehensive plans of services for the mentally disabled are requested to complete this reply form as soon as possible and mail it to:

Carl Letson
Legislative Associate
Assembly Committee on Mental Health, Mental Retardation and
Developmental Disabilities
Room 522 - Capitol
Albany, New York 12248
(518) 455-4371
(518) 455-4693 (fax)

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I plan to attend the public hearing on establishment of statewide goals and objectives; statewide comprehensive plans for the mentally disabled to be conducted by the Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities and the Assembly Committee on Alcoholism and Drug Abuse on January, 24, 2002 in New York City

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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.

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I will address my remarks to the following subjects:
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_____ _____________________________________

_____ _____________________________________

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I do not plan to attend the above hearing.

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I would like to be added to the Committee mailing list for notices and reports.

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I would like to be removed from the Committee mailing list.

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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:
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NAME: ______________________________________________________

TITLE: _______________________________________________________

ORGANIZATION: _____________________________________________

ADDRESS: ___________________________________________________

TELEPHONE: _________________________________________________


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