CIV-LT-47 – Affirmation of Service of Judgment with Notice of Entry – New York

This form, CIV-LT-47 – Affirmation of Service of Judgment with Notice of Entry, is used in the Civil Court of the City of New York, specifically in Housing Part cases, to affirm the service of a judgment with notice of entry.

To complete this form, follow these steps:

Court Information

• L&T Index Number: Enter the Landlord-Tenant index number for your case.
• County: Enter the county where the court is located.
• Housing Part: Specify the housing part if applicable.

Case Title:

• Petitioner(s): Write the name(s) of the petitioner(s) (plaintiff).
• Respondent(s): Write the name(s) of the respondent(s) (defendant).

Deponent Information

• State of New York, County of: Enter the state and county where the affirmation is being made.
• Print Name of Deponent: Clearly print the full name of the person affirming (deponent).

Affirmation Details

• Over 18 and Not a Party: Check the box confirming you are over 18 years old and not a party to the action.
• Service Details:
  • Date of Service: Enter the exact day you served the judgment (e.g., 5th day of March 2024).
  • Recipient Name: Enter the name of the person or entity served.
  • Recipient Address: Enter the full address, including city, state, and zip code, where the judgment was mailed.

Affirmation Statement

• Current Date: Fill in the date you are signing the form (e.g., this 5th day of March, 2024).
• Printed Name and Signature: Print your name and sign in the designated spaces.

Instructions for Specific Fields

• County: Enter the county where the court case is filed.
• L&T Index Number: Enter the specific index number for your Landlord-Tenant case.
• Petitioners and Respondents: List the names of all petitioners and respondents involved in the case.
• Deponent: The person serving the document must provide their information here.
• Service Date and Method: Clearly state the date of service and how it was carried out (e.g., by mail).
• Recipient Information: Provide the full name and address of the recipient of the served judgment.

Penalties for Perjury

• Be aware that false statements can result in penalties, including fines or imprisonment.

This free housing court form, which can be found on the New York Courts website, does not incur any fees for completion.