New York State Assembly
Excellence in Reading
Certificate

Information Form

Child’s Name
School
Parent or Guardian Name
Address
Phone/E-mail
Number of Days Completed.
Favorite Books

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

Assemblywoman
Ann-Margaret Carrozza
213-33 39th Avenue, Suite 238
Bayside, NY 11361
718-357-3588

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