JCOPE Notice of Appearance Form

This form must be completed by every person or entity appearing before the New York State
Joint Commission on Public Ethics (the “Commission”) on behalf of itself or another individual
or entity in a representative capacity in any enforcement, investigatory, or similar matter before
the Commission, other than if such individual or entity is appearing solely in its capacity as a
“lobbyist” or “client” as those terms are defined in Article 1-A of the Legislative Law and related
regulations. This form shall be filed with the Commission before or upon such appearance.

Acting in the capacity of
Acting in the capacity of
I, , appear for the Client listed in paragraph 2 in the above referenced proceeding.
Sign above