CIV-GP-74-BNew YorkFillable

Affirmation of Compliance with the Insurance Law

New York Local Civil Courts · Civil Lawsuits

Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗

Affirmation by a claimant that the original summons was served on the Superintendent of Insurance with the required fee, as Insurance Law section 1213 requires.

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