(b) No special form is required. The following form is a suggestion:

STATE OF NEW YORK

INDUSTRIAL BOARD OF APPEALS

_____________X

Defense Emergency Act Appeal

by Petition

(Insert name of Appellant)

_____________X

1. Appellant is (a resident of , residing at) (a New York corporation

with offices at) (insert address) engaged in

(state nature of business)

at (insert plant address) .

___________________.

3. Application therefor was made on (insert date) to the Commissioner

of Labor, who has taken the following action:

4. The facts justifiying the dispensation are:

(Type name of Appellant)

(Signature of Appellant or authorized representative)