PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on the affordability and accessibility of long term care insurance are requested to complete this reply form and mail, email, or fax it by December 17, 2012 to:

Eric Jacobsen
Analyst, Assembly Committee on Insurance
Room 520 - Capitol
Albany, New York 12248
Email: jacobsene@assembly.state.ny.us
Phone: (518) 455-4311
Fax: (518) 455-7095
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I plan to attend the public hearing on long term care insurance to be conducted by the Assembly Committee on Insurance on December 18, 2012.
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I plan to make a public statement at the hearing. My statement will be limited to 10 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.
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I will address my remarks to the following subjects:


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I do not plan to attend the above hearing.
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I would like to be added to the Committee's mailing list for notices and reports.
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I would like to be removed from the Committee's mailing list.
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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:


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