STATE OF NEW YORK
                                     DIVISION OF MILITARY AND NAVAL AFFAIRS
                                          STATE EMERGENCY MANAGEMENT OFFICE
                                                      STANDARD MESSAGE FORM

 __________________________________________________________________________
|To:  Jurisdiction|Office or Agency||From:  Jurisdiction|Office or Agency  |
|                 |                ||                   |                  |
|_________________|________________||___________________|__________________|
|~~~|D a t e |Time(24Hr)|Month|Year||Info copy to: (Originator &/or Op use)|
|DTG|        |          |     |    ||                                      |
|___|________|__________|_____|____||______________________________________|
|OPS Chief |Authority:   |Priority:||        |                    |Msg. No.|
|          |             |         || Flash  |     Circle One     |        |
|Use Only: |             |Check One||--------|--------------------|        |
|          |             |         || Urgent | Expedite | Routine |        |
|__________|_____________|_________||________|__________|_________|________|

   P R I N T  |     O N E    |   W O R D    |    P E R     |  S P A C E
              |              |              |              |            
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
              |              |              |              |
______________|______________|______________|______________|______________
ORIGINATOR'S SIGNATURE (Print)

 __________________________________________________________________________
|For       |   Date  Time  System Operator   Date   Time  System Operator  |
|          | |------|-----|---------------| |------|-----|----------------||
|Operator's|R|      |     |               |T|      |     |                ||
|          | |------|-----|---------------| |------|-----|----------------||
|Use       | |      |     |               | |      |     |                ||
|          | |------|-----|---------------| |------|-----|----------------||
|__________|_______________________________________________________________|