(Name of Applicant in full)
Application No. ________
_________
(Place and date) 19________
To COMMISSIONER OF TRANSPORTATION
STATE OF NEW YORK
Albany, N. Y.
(Name of carrier) by,
(Name of officer, specifying title)
does hereby petition to the Commissioner of Transportation, State of New York, that he (it) be permitted, under section 172 of Transportation Law, to put in force the following provisions to become effective ________days after the filing thereof with the Commissioner:
(Here show matter as directed by § 826.8 [ e][1].)
Your petitioner further represents that the said (state whether rates, charges, classification ratings, or other provisions) above mentioned will be published in (here show matter as directed by § 826.8 [ e][2].)
(Here state matter as directed by § 826.8 [ e][3].)
(Here state matter as directed by § 826.8 [ e][4].)
(Here state fully matter as directed by § 826.8[e][5].)
(Here set forth the justification as directed by § 826.8[e][6].)
_________
(Name of carrier)
By
_________
(Name and title)
Subscribed and sworn to before me this________day of ________19 ________
_________
(Notary Public)
N.Y. Comp. Codes R. & Regs. Tit. 17 § 826.8