Fiscal Note Request

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Requestor Information

Name*
Ex: Mr. John Smith

Title*

Office*

Phone*

E-Mail*

Recipient E-Mail*

Legislation No.*
Ex: A12345/S67890/LBDC LBDC No. or Bill No. is required.

Request Title*
Ex: Increase benefit for certain members

Sponsors*
Ex: Assemblyman/Senator

Description*
Ex: To allow group to benefit...

Purpose*
Ex: This bill is intended to...

Previous Fiscal Note
Ex: FN 20 xx-xx Please provide if the Office of the Actuary previously provided a Fiscal Note for a similar bill.

Please do not submit Social Security No. or other personal identifying information.

Proposed Legislation Choose a file…no file selected

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