Fillable Printable Form SR-60 - Supporting Affirmation - New York

Form SR-60 - Supporting Affirmation - New York

www.dmv.ny.gov

SUPPORTING AFFIRMATION

Insurance Services Bureau

6 Empire State Plaza

Albany New York 12228-0330

Section 332 of the Vehicle and Traffic Law authorizes the Commissioner of Motor Vehicles to suspend the driver license and

registration privileges of any person (or company) who fails to pay a judgment of more than $1,000 that results from the use or

operation of any motor vehicle.

If you or your client obtain a judgment (or have already obtained a judgment), that you believe will qualify, please complete, sign

and return this affirmation with the following documents:

l a copy of the outstanding judgment, with ORIGINAL court or attorney certification.

l a copy of the complaint and summons.

l a copy of any available police accident report (MV-104A) or motorist accident report (MV-104).

WE WILL CONTACT YOU TO TELL YOU ABOUT ANY SUSPENSION ACTION OR OTHER ACTIVITY IN THIS CASE.

1. Judgment debtor’s name _____________________________________________ Date of birth____________________

Present address________________________________________________________________________________________

License ID number ____________________________________________________________________________________

License plate number_________________________________

2. Date of occurrence ______________________________________

3. Has the judgment debtor appealed the judgment? ............

o Yes o No

4. Has the time to appeal the judgment expired? .................. o Yes o No

5. Are any appeals pending? ................................................ o Yes o No

6. Amount now actually due on the judgment $ ________________________

AFFIRMATION TO BE COMPLETED

CERTIFICATION:

I affirm under the penalties of perjury that the above information is true and correct. False statements made in this document are

punishable under Section 210.45 of the Penal Law.

Signature

ç __________________________________________________________ Date __________________________

SR-60 (9/15)

Send this affirmation and all requested documents to the Insurance Services Bureau at the address shown at the top of the page.