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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 22. Judiciary |
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Subtitle D. Forms |
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Chapter IX. Forms for Commercial Claims Parts of Court |
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UCS-119 Application to file claim |
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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 CERTIFICATION: (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 Certification: (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 |