STATE OF NEW YORK PUBLIC EMPLOYMENT RELATIONS BOARD WWW.PERB.NY.GO V File an original and (4) copies of this charge with the Director of Employment Practices and Representation, Public Employment Relations Board, PO BOX 2074, ESP AGENCY BLD 2, FL 18-20, ALBANY, NY 12220-0074. If more space is required for any item, attach additional sheets, numbering each item accordingly. DO NOT WRITE IN THIS SPACE Case No.: Date Received: PETITION BY EMPLOYER FOR INVESTIGATION PURSUANT TO SECTION 705 OF THE NEW YORK STATE EMPLOYMENT RELATIONS ACT 1.Name of petitioning employer 2.General nature of business 3.Types, classifications or groups of employees which the petitioner claims constitutes the appropriate bargaining unit 4.Number of employees within such unit or units 5. Approximate total number of employees 6.Address at which employees in such unit or units are employed 7.Name and addresses of any known individuals or labor organizations who claim to represent any of the employees in such bargaining unit(s) 8.Any other facts which petitioner considers relevant . 9.The undersigned hereby alleges that a question or controversy has arisen concerning the representation of the employees in the above unit(s), in that (use additional sheet(s) if necessary): 10.Approximate percentage and volume of sales to, and sales to, and purchases from, points outside New York State. 11.Any other facts concerning interstate commerce. American LegalNet, Inc. www.FormsWorkFlow.com The undersigned requests that the New York State Public Employment Relations Board investigate such question or controversy. } ss.: Name of petitioner. (If a corporation, the name and Official position of the person signing this petition.) 205205205205205205205205205. Being duly sworn, deposes and says 205205205205205205205205205205205205205205205205205205205205205205205205 that he/she is 205205205205205205205205205205.. of the petitioner herein; that the same is true to his/her own knowledge, except asto the 205205205205205205205205205205 205205205205205205205205205205205205205205 matters therein stated to be alleged on information and belief, and as (Signature and Title) to those matters he/she believes to be true. 205205205205205205205205205205205205205205205205205205205205205 205205205205205205205205 Address 205205205205205205205205205205205205205205205205205. (Signature of Petitioner222s Representative) 205205205205205205205205205205205205205205205205205205205205205205205 Include Zip Code Sworn to before me this day of 20 Telephone: 205205205205205205205205205205205205205205205205205205205 Email: 205205205205205205205205205205205205205205205205205205205205.. 205205205205205205205205205205205205205205205205205205205205205205205205205205205205205 Fax No: 205205205205205205205205205205205205205205205205205205205205 ICRR (5-17) STATE OF NEW YORK CITY OF COUNTY OF American LegalNet, Inc. www.FormsWorkFlow.com