New York Codes, Rules and Regulations
Title 12 - DEPARTMENT OF LABOR
Chapter I - Industrial Board Of Appeals
Subchapter B - Rules Of Procedure And Practice
Part 70 - Appeals From Minimum Wage Orders And Regulations Under Sections 657 And 676 Of Labor Law
Section 70.3 - Form and contents of petition

(a) contain a caption in the following form:

STATE OF NEW YORK

INDUSTRIAL BOARD OF APPEALS

X..........................................................................................................

In the Matter of the Petition of:

(

insert name of petitioner

)

.........................................................................................................

Petitioner,

:

To review under Section (657 or 676) of the.. :.........................................................................................................

Labor Law:

(state minimum wage order or regulation.. :........................................................................................................

to be reviewed)

-against-........................................................................................................

The Commissioner of Labor,.. :........................................................................................................

.........................................................................................

Respondent.

:

X....................................................................................................

(b) state the address of the petitioner;

(c) identify or set forth the wage order or regulation in issue;

(d) state whether the petitioner is an aggrieved person in interest, as defined in section 657 or 676, and show the nature of the interest and the respects in which the petitioner is aggrieved;

(e) state clearly the grounds on which the wage order or regulation being challenged is contrary to law;

(f) show any other material facts, by affidavit or other reliable and relevant evidence, to support the petitioner's contentions and the relief requested;

(g) specify with particularity the precise relief requested; and

(h) be signed by petitioner, or authorized representative.