STATE OF NEW YORK PUBLIC EMPLOYMENT RELATIONS BOARD WWW.PERB.NY.GOV 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 FOR INVESTIGATION AND CERTIFICATION OF REPRESENTATIVES PURSUANT TO SECTION 705 OF THE NEW YORK STATE EMPLOYMENT RELATIONS ACT 2.Address of Employer (including Zip Code) 3.General nature of business 4. The types, classifications, or groups of employees which the petitioner claims constitutes the appropriate bargaining unit(s) 7.Address of which employees in such unit(s) are employed 8.Names and addresses of any other known individuals or labor organizations who claim or may claim to represent any of the employees in such bargaining unit(s) 9.Does the petitioner request certification as the collective bargaining representative of the employees within the bargaining unit(s) claimed to be appropriate? 10.The undersigned hereby alleges that a question or controversy has arisen concerning the representation of the employees in the above bargaining unit(s) in that: 11.Approximate percentage and volume of sales to, and purchases from, points outside New York State 12.Any other facts concerning interstate commerce 13.Has the National Labor Relations Board accepted or declined jurisdiction over the employer? If unknown, state so: 1.Name of Employer Telephone 5. Number of employees within such unit(s) 6.Approximate total number of employees American LegalNet, Inc. www.FormsWorkFlow.com The undersigned requests that the New York State Public Employment Relations Board investigate such controversy and certify to the parties the name or names of the representatives designated or selected by said employees. } ss.: 205205205205205205205205205. Being duly sworn, deposes and says 205205205205205205205205205205205205205205205205205205205205205205205 that he/she is .205205205205205205205205205.. of the petitioner herein; that the same is true to his/her own knowledge, e By205205205205205205205205205205205205205205205205205205205205205205205 matters therein stated to be alleged on information and belief, and as Signature and Title of Petitioner222s Representative) to those matters he/she believes to be true. Name of employees or representatives filing this petition. (If a labor organization, give the name and official position of person acting for the organization.) STATE OF NEW YORK CITY OF COUNTY OF American LegalNet, Inc. www.FormsWorkFlow.com