Sec. 720-2.5. Appendix: form for application for short notice

(Name of Corporation or Municipality)

Public Service Commission

3 Empire State Plaza

 

(Date)

Albany, New York 12223-1350

(Name of Public Utility), hereby applies under

Subdivision 12 of Section 66 (Electricity or Gas)

or

Subdivision 10 of Section 80 (Steam)

or

Subdivision 10 of Section 89-c (Water)

or

Subdivision 2 of Section 92 (Telephone)

of the Public Service Law for permission to put the following in effect on (Date):

(Here list items for which permission is requested) This application is based on the following special circumstances and conditions:

 

 

(Name of Public Utility)

By (Signature of Officer)

(Title of Officer)

AFFIDAVIT

State of New York

County of _______

 

being duly sworn, says that (s)he is the officer named in the foregoing application that (s)he has read said application and knows the contents thereof, and that the same is true of his/her own knowledge, except as to the matters therein stated to be alleged on information and belief, and as to those matters (s)he believes it to be true.

Subscribed and sworn to before me this

____

day of

____

 

(Name of Affiant)

(Notary Public)