PO Box 2074 Empire State Plaza Agency Building 2, 20 th Floor Albany, New York 12220 - 2074 Phone: (518) 457 - 2578 I Fax: (518) 457 - 2664 www.perb.ny.gov Consent to Electronic Case numbers: Charging party: Respondent(s): I, (enter your name) , am (check one) the representative of a party in the above - captioned action. a self - represented party in this matter. I hereby ion and Order by registered or certified Decision and Order via email will be deemed service of the decision by the Board, and service will be complete when the email is sent. Signature: Date: Print name: Party Represented: Email this completed form with Exceptions, Cross - Exceptions, or Response to boardsecretary@perb.ny.gov . (Form number/date updated PERB102 (2/19)) American LegalNet, Inc. www.FormsWorkFlow.com