STATE OF NEW YORK
INDUSTRIAL BOARD OF APPEALS
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Defense Emergency Act Appeal.......................................................................................................
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by
Petition
(Insert name of Appellant).......................................................................................................
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(insert address) engaged in.......................................................................................................
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(state nature of business).....................................................................................
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at (insert plant address)......................................................................................
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(insert date).. to the Commissioner............................................................
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of Labor, who has taken the following action:________________________
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(Type name of Appellant)........................................................
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(Signature of Appellant or authorized representative)
N.Y. Comp. Codes R. & Regs. Tit. 12 § 69.3