A. Format:

STATE OF NEW MEXICO

BEFORE THE OCCUPATIONAL HEALTH AND SAFETY REVIEW COMMISSION

[NAME OF COMPLAINANT OR PETITIONER],

[complainant/petitioner],

v. No. [insert case no.]

[NAME(S) OF RESPONDENT(S)],

respondent[s].

AFFIDAVIT OF POSTING

STATE OF [NAME OF STATE IN WHICH AFFIDAVIT SIGNED] )

) ss.

COUNTY OF [NAME OF COUNTY IN WHICH AFFIDAVIT SIGNED] )

[Name of person signing affidavit], being duly sworn, states:

1. I am the [title] of the [respondent/petitioner], [name of party], and I am authorized to make this affidavit.

2. I posted copies of the notice to affected employees ([specific type of notice]), [with an attached copy of the (title of attached document),] in accordance with 11 NMAC 5.5.203.A [now Subsection A of 11.5.5.203 NMAC], on [date of posting].

[Signature] ____________________________________

[TYPED OR PRINTED NAME]

[Address of signer (use as many lines as necessary)]

[Signer’s telephone number]

SUBSCRIBED AND SWORN TO before me by [name of person signing affidavit] on [date].

[Signature of notary] ____________________________

Notary public

My commission expires:

[Expiration date]___________________

B. Usage note: If applicable, include certificate of service (Section 1001) [now 11.5.5.1001 NMAC], on or immediately following the signature page.

[1/1/84, 1/1/94, 1/1/96; Recompiled 11/30/01]