214 Kent Ave. #256, Endwell, NY 13760

Phone Number

(844) 469-7362

Email Us

Info Here

Install our APP

More Info

Financial Disclosure

Return to Forms

Financial Disclosure

* Indicates a Required Field

Statement of Compliance:

I attest that:

  • I have read the New York State ENA Financial Disclosure Policy before completing this Disclosure Statement. (Click here to read it.)
  • I understand that the terms "family relationship" and "immediate family" as used in reference to a Financial Disclosure, refer to any parent, spouse, domestic partner, or child.
  • I attest that I will notify NYSCENA if there are any changes to the above or relevant relationships within the next 12 Months.

By pressing submit below, I attest that the typed signature above represents my signature.