NY DMV Supporting Affirmation for Insurance
The NY DMV Supporting Affirmation is a legal document required for individuals or companies who failed to pay a judgment over $1,000. This affirmation needs to be completed and returned along with necessary supporting documents. Ensure all information is accurate to avoid legal consequences.
Edit, Download, and Sign the NY DMV Supporting Affirmation for Insurance
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out this form, start by gathering relevant information and documents. Ensure that all required fields are filled accurately. After completing the form, review it thoroughly before sending it to the specified address.

How to fill out the NY DMV Supporting Affirmation for Insurance?
1
Gather all necessary documents like the judgment, complaint, and accident reports.
2
Fill in the judgment debtor's details including name, address, and ID number.
3
Indicate the date of occurrence and any appeals status.
4
Enter the amount due on the judgment.
5
Sign and date the affirmation before submission.
Who needs the NY DMV Supporting Affirmation for Insurance?
1
Individuals who have received a judgment exceeding $1,000 and need to affirm their payment status.
2
Lawyers representing clients who have experienced a judgment linked to vehicle usage.
3
Insurance companies requiring validation of judgments from clients.
4
Companies involved in vehicle operations facing legal judgments.
5
Court officials facilitating the processing of legal documents.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the NY DMV Supporting Affirmation for Insurance along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.

Edit your NY DMV Supporting Affirmation for Insurance online.
Editing this PDF on PrintFriendly is simple and user-friendly. Just upload your PDF and click on the area you wish to modify. You can make adjustments, add text, or correct any inaccuracies directly within the document.

Add your legally-binding signature.
Signing your PDF on PrintFriendly is fast and convenient. After editing, you can easily add your signature in the designated area. This ensures that your document is finalized and ready for submission.

Share your form instantly.
Sharing your PDF on PrintFriendly has never been easier. Once you have edited or signed your document, you can directly generate a shareable link. This allows you to distribute your document to others effortlessly.
How do I edit the NY DMV Supporting Affirmation for Insurance online?
Editing this PDF on PrintFriendly is simple and user-friendly. Just upload your PDF and click on the area you wish to modify. You can make adjustments, add text, or correct any inaccuracies directly within the document.
1
Open the PDF in PrintFriendly.
2
Click the section you want to edit.
3
Make your changes in the text fields.
4
Once completed, click save to apply your edits.
5
Download the modified PDF to your device.

What are the instructions for submitting this form?
To submit this form, ensure all required fields are completed and accurately filled out. Attach the necessary documents such as the judgment copy and police reports. You can submit the form via mail to the Insurance Services Bureau, 6 Empire State Plaza, Albany, New York 12228-0330 or through legal representation if applicable.
What are the important dates for this form in 2024 and 2025?
Important dates regarding the submission of this form typically align with court or judgment deadlines. It’s essential to stay informed of any updates by regularly checking the DMV website or contacting their office. For 2024 and 2025, ensure to submit your documents promptly to prevent any legal consequences.

What is the purpose of this form?
The purpose of this form is to affirm an individual’s or entity’s status concerning a judgment resulting from the operation of a motor vehicle. It serves as a critical link in maintaining compliant driving privileges and addressing outstanding financial obligations linked to vehicle use. Completing this affirmation ensures that the necessary parties are notified and can take appropriate action.

Tell me about this form and its components and fields line-by-line.

- 1. Judgment debtor's name: The full name of the individual or entity liable for the judgment.
- 2. Present address: The current residential or business address of the judgment debtor.
- 3. License ID number: The unique identification number associated with the driver's license.
- 4. License plate number: The number associated with the vehicle's license plate.
- 5. Date of occurrence: The date when the incident leading to the judgment occurred.
- 6. Appeals status: Information regarding whether the judgment has been appealed or if appeals are pending.
- 7. Amount now actually due: The current amount that needs to be settled concerning the judgment.
- 8. Date of birth: The judgment debtor's birth date for verification.
What happens if I fail to submit this form?
Failing to submit the affirmation form may lead to significant consequences, including the suspension of driving privileges. The DMV relies on this affirmation to manage outstanding judgments effectively. Therefore, it is crucial to ensure timely submission to avoid legal complications.
- License Suspension: If the form is not submitted, the DMV may suspend your driving license.
- Increased Liability: Continuing to drive without resolving the judgment can lead to further legal actions.
- Legal Penalties: Failure to provide the necessary information can result in legal repercussions.
How do I know when to use this form?

- 1. Upon Receiving Judgment: Submit the form immediately following any judgment you receive regarding vehicle use.
- 2. When Making Payments: Use the form to confirm payment statuses related to outstanding judgments.
- 3. For Legal Representation: Lawyers should assist their clients in submitting this form to avoid legal issues.
Frequently Asked Questions
What is the purpose of the NY DMV Supporting Affirmation?
It is used to affirm a judgment regarding a vehicle-related payment obligation.
How do I fill out the affirmation form?
Gather your documents, fill in the required fields, and review for accuracy before submitting.
Can I edit this form on PrintFriendly?
Yes, you can easily edit this PDF to ensure all information is accurate.
How do I submit the completed form?
Send the form along with the required documents to the Insurance Services Bureau at the designated address.
What happens if I don't submit this form?
Failure to submit may result in the suspension of your driving privileges.
Is it necessary to provide original documents?
Yes, original court or attorney certified documents are required.
Can I sign this PDF electronically?
Yes, you can add your electronic signature using PrintFriendly.
Is the form available for download?
Yes, once filled out, you can download the completed form.
How long does it take to process my submission?
Processing times may vary, so contact the bureau for specific inquiries.
Who should I contact if I have questions?
Reach out to the Insurance Services Bureau for assistance with any inquiries.
Related Documents - DMV Affirmation Form

Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.

Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.

TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.

Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.

Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.

Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.

Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.

MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.

Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.

Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.

Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.

Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.