Fillable LICENSEE INFORMATION (Must fill-in all boxes) (City of New York)

Fill Online, Printable, Fillable, Blank LICENSEE INFORMATION (Must fill-in all boxes) (City of New York) Form

Use Fill to complete blank online CITY OF NEW YORK pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

LICENSEE INFORMATION (Must fill-in all boxes) (City of New York)

On average this form takes 5 minutes to complete

The LICENSEE INFORMATION (Must fill-in all boxes) (City of New York) form is 1 page long and contains:

  • 0 signatures
  • 3 check-boxes
  • 20 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of New York

BROWSE CITY OF NEW YORK FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
*Agent can be any individual residing or with a place of business in the five boroughs that the Licensee assigns to accept service.
Rev. 1/18
LIC50: AUTHORIZATION FOR
SERVICE OF PROCESS by AGENT
LICENSEE INFORMATION (Must fill-in all boxes)
1) Last Name
2) First Name
3) Middle Initial
4) License Type
5) License Number
6) Associated Business Name
7) Title at Business
NAMED AGENT INFORMATION (New York City address ONLY; PO Boxes are not accepted)
1) Last Name
2) First Name
3) Middle Initial
4) Street Address
5) Apt./Bldg. #
6) City
7) State
8) Zip Code
I hereby affirm that I am authorized to make decisions on behalf of the above named corporation, partnership, or other
corporate entity.
I hereby agree that the above Named Agent* may accept service of Notices of Violation (NOV)/Summonses issued by the
New York City Department of Buildings (DOB). I also agree that service to this Agent at the address listed above shall be
deemed to be valid service of the NOVs/Summonses under New York City Charter 1049-a, section 6-08 of the rules of
OATH Hearings Division and other applicable laws to allow for the docketing of judgments. I further agree not to raise any
defect with respect to service for any NOVs/Summonses received from DOB at the address above, in any forum, including
before a hearing officer of OATH/ECB, the Environmental Control Board itself, or in any court of law.
I, ____________________________________, acknowledge that failure to designate an agent in New York City (NYC) or
maintain a NYC address for receipt of service, constitutes a waiver of any challenges to service of process.
NAME (print)
NOTARIZATION
State of New York, County of:
NOTARY SEAL
SIGNATURE
Sworn to (or affirmed) before me under
penalty of perjury this
______ day of ________________
20 ______.
DATE
NOTARY SIGNATURE
Must be typewritten
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

LICENSEE INFORMATION (Must fill-in all boxes) (City of New York)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 7 November 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document