22 CRR-NY D IX Form UCS-119NY-CRR
22 CRR-NY D IX Form UCS-119
22 CRR-NY D IX Form UCS-119
UCS-119 Application to file claim
UCS-119 (Rev. 11/90)
State of New York
FOR CLERK'S USE ONLY
__
Court of
__
Notice was mailed on
day of
, 19,
to
(Address of Defendant)
Date of delivery
Home address of person
who signed receipt
(from the receipt form)
Application: Small Claim
__
Commercial Claim
__
Commercial Claim
__
(Consumer Transaction)
Filing Fee:
Small Claim
– $ 3.00 + postage
Commercial Claim
– $20.00 + postage
Dated ______
Name of Claimant ______
Address (if commercial claim, give Principal Office Address)
Telephone ______
–against–
Name if Defendant ______
Address (Home or Bus./Place of Employment)
COMPLETE THIS SECTION FOR COMMERCIAL CLAIM
1CERTIFICATION: (NYCCA 1803–A; UCCA 1803–A; UDCA 1803–A)
I hereby certify that no more than five (5) actions or proceedings (including the instant action or proceeding) pursuant to the commercial claims procedure have been initiated in the courts of this State during the present calendar month.
Signature of Claimant
Signature of Notary/Clerk/Judge
UCS-119 (Rev. 11/90)
COMPLETE THIS SECTION FOR COMMERCIAL CLAIM
ARISING OUT OF A CONSUMER TRANSACTION
1Certification: (NYCCA 1803–A; UCCA 1803–A; UDCA 1803–A)
I hereby certify that I have mailed a demand letter by ordinary first class mail to the party complained against, no less than ten (10) days and no more than one hundred eighty (180) days before I commenced this claim.
I hereby certify, based upon information and belief, that no more that five (5) actions or proceedings (including the instant action or proceeding) pursuant to the commercial claims procedure have been initiated in the courts of this State during the present calendar month.
Signature of Claimant
Signature of Notary/Clerk/Judge
Footnotes
1
NOTE: The commercial claims part will dismiss any case where this certification is not made.
1
NOTE: The commercial claims part will not allow your action to proceed if this certification is not made and properly completed.
22 CRR-NY D IX Form UCS-119
Current through May 31, 2021
| End of Document |
IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.