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Case Header
SUPREME COURT OF THE STATE OF NEW YORK
County of*
Index/Docket #*
Plaintiff / Petitioner *
Defendant / Respondent*
STATEMENT OF AUTHORIZATION FOR ELECTRONIC FILING

New York State Courts Electronic Filing System ("NYSCEF")
I hereby authorize LONG ISLAND PROCESS SERVERS LIMITED through its designated employees ("the filing agent") to utilize his/her NYSCEF filing agent ID to file Proofs of Service and Affirmations/Affidavits/Returns of Service (or non-service) on my behalf and at my direction in any e-filed matter in which I am counsel of record OR the party initiating the matter through the NYSCEF system, as provided in Section 202.5-b of the Uniform Rules for the Trial Courts.
Filing as:*

I am an attorney admitted to this court, authorizing a single matter.I am a self-represented (Pro Se) litigant, using the NYSCEF system for this matter.
Attorney Name*

First NameLast Name
Pro Se Participant Name*

First NameLast Name
Attorney Registration #*
NYSCEF User ID
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Signature*

Clear
Dated*

DayMonthYear
Date
Printed Name*
Phone*
Email Address*
example@example.com
Firm / Department or Pro Se*
Should be Empty:

STATEMENT OF AUTHORIZATION FOR ELECTRONIC FILING