New York State Assembly
Excellence in Reading
Certificate
Information Form


Name of Child


School

Grade


Parent's Name


Street Address


City or Town

Zip

Number of days completed

Favorite Books





To receive your certificate, please complete the above
form and send it with the attached calendar to:

Assemblyman
N. Nick Perry

903 Utica Avenue, 1st Floor
Brooklyn, New York 11203
(718) 385-3336


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