"Roster of Process Servers" - New York City

Roster of Process Servers is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.

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Download "Roster of Process Servers" - New York City

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42 Broadway
ROSTER OF PROCESS SERVERS
New York, NY 10004
Dial 311
Process Serving Agency Name:
(212-NEW-YORK)
nyc.gov/dca
Process Serving Agency
DCA License Number (if applicable):
Business Address:
Process Serving Agencies must submit a list of all Process Server Individuals who
will serve process on behalf of the Agency. Please provide required information
below. Attach additional papers as necessary.
Process Server
Process Server
DCA
Does this individual serve
Individual Name
Individual Address
License
process exclusively as an
Number
employee of the Agency?
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
IMPORTANT REQUIREMENTS ABOUT UPDATING INFORMATION:
Process Serving Agencies must submit an updated Roster of Process
Servers to the Department of Consumer Affairs (DCA) within five (5) days of
assigning service to new Process Server Individuals.
If a process server ceases to serve process exclusively for the Agency as an
employee, the Agency must notify DCA within five (5) days of the change in
writing. The notification must include the process server’s name, address,
and DCA license number.
Over
42 Broadway
ROSTER OF PROCESS SERVERS
New York, NY 10004
Dial 311
Process Serving Agency Name:
(212-NEW-YORK)
nyc.gov/dca
Process Serving Agency
DCA License Number (if applicable):
Business Address:
Process Serving Agencies must submit a list of all Process Server Individuals who
will serve process on behalf of the Agency. Please provide required information
below. Attach additional papers as necessary.
Process Server
Process Server
DCA
Does this individual serve
Individual Name
Individual Address
License
process exclusively as an
Number
employee of the Agency?
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
IMPORTANT REQUIREMENTS ABOUT UPDATING INFORMATION:
Process Serving Agencies must submit an updated Roster of Process
Servers to the Department of Consumer Affairs (DCA) within five (5) days of
assigning service to new Process Server Individuals.
If a process server ceases to serve process exclusively for the Agency as an
employee, the Agency must notify DCA within five (5) days of the change in
writing. The notification must include the process server’s name, address,
and DCA license number.
Over
Agencies that do not provide updated information are subject to fines or other sanctions.
I am authorized (e.g., owner, sole proprietor, general partner, director, corporate officer, or shareholder
owning 10% or more of company stock) to complete and sign this form on behalf of the Process Serving
Agency named on the front.
I understand that falsification of any statement made herein is an offense punishable by a fine or
imprisonment or both.
_______________________________
_______________________________
Signature
Print Name
_______________________________
_______________________________
Position/Title
Date
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