"Emergency Contact Entry Form" - New York

Emergency Contact Entry Form is a legal document that was released by the New York State Division of Criminal Justice Services - a government authority operating within New York.

Form Details:

  • The latest edition currently provided by the New York State Division of Criminal Justice Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Division of Criminal Justice Services.

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New York State Division of Criminal Justice Services
Office of Public Safety
EMERGENCY CONTACT ENTRY FORM
First Name:
Middle Initial:
Last Name :
Title*
Agency Name:
Agency Address:
City:
State:
Zip:
Phone Direct:
Phone Cell:
Fax Number:
Pager Number:
E-Mail Address:
*Title – must be CEO of the Agency
Return Form to:
NYS Division of Criminal Justice Services
Alfred E. Smith State Office Building
Office of Public Safety
rd
80 South Swan St., 3
Floor
Albany, NY 12210-8002
ATTN: Ms. Kimmarie Victoria
New York State Division of Criminal Justice Services
Office of Public Safety
EMERGENCY CONTACT ENTRY FORM
First Name:
Middle Initial:
Last Name :
Title*
Agency Name:
Agency Address:
City:
State:
Zip:
Phone Direct:
Phone Cell:
Fax Number:
Pager Number:
E-Mail Address:
*Title – must be CEO of the Agency
Return Form to:
NYS Division of Criminal Justice Services
Alfred E. Smith State Office Building
Office of Public Safety
rd
80 South Swan St., 3
Floor
Albany, NY 12210-8002
ATTN: Ms. Kimmarie Victoria