Notice of Appearance, Answer, and Certificate of Service - PDF

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					                                      STATE OF CALIFORNIA
                               PUBLIC EMPLOYMENT RELATIONS BOARD

                               NOTICE OF APPEARANCE FORM

CASE NAME:     __________________________________________________________

          V.
               __________________________________________________________


CASE NUMBER:   __________________________________________________________


NAME OF PARTY: _________________________________________________________


DATE FILED:    __________________________________________________________


  I, the undersigned party, hereby designate as my representative the person whose
  name and address appear below, and authorize such representative to appear on my
  behalf in this proceeding.    This designation shall remain valid until I file a
  written revocation of it with the Public Employment Relations Board.


   ________________________________             ________________________________
   (Signature)                                  (Name of Representative)

   ________________________________              ________________________________
  (Printed Name)                                (Title)

   ________________________________             ________________________________
   (Title)                                      (Mailing Address)

   ________________________________             ________________________________
   (Date)                                       (City)                   (Zip)

                                                (_____)_________________________
                                                (Telephone Number)       (Ext)




(Board Agent: ________)                                        PERB 920 (3/99)

				
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