New York State Assembly
Excellence in Reading
Certificate
Information Form

Name of Child

School
Grade

Parent's Name

Street Address

City or Town
Zip

Number of days completed

Favorite Books



To receive your certificate, please complete the above
form and send it with the attached calendar to:

Assemblymember
Charles D. Lavine
70 Glen Street, Suite 100
Glen Cove, New York 11542
(516) 676-0050

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