Form I-55 "Affidavit in Support of Late Filing of Ovs Claim" - New York

What Is Form I-55?

This is a legal form that was released by the New York State Office of Victim Services - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the New York State Office of Victim Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form I-55 by clicking the link below or browse more documents and templates provided by the New York State Office of Victim Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form I-55 "Affidavit in Support of Late Filing of Ovs Claim" - New York

188 times
Rate (4.6 / 5) 9 votes
ANDREW M. CUOMO
ELIZABETH CRONIN ESQ.
Governor
Director
AFFIDAVIT IN SUPPORT OF LATE FILING OF OVS CLAIM
(TO BE COMPLETED BY CLAIMANT)
NAME : _____________________________________________ CLAIM NO:__________________
DATE OF CRIME: ____________________ LOCATION OF CRIME: _________________________
DATE REPORTED TO POLICE: _____________DATE CLAIM FILED WITH THE OVS:__________
DATE YOU WERE INFORMED OF THE OFFICE OF VICTIM SERVICES: _____________________
LIST THE FACTORS WHICH CAUSED THE DELAY IN FILING THE CLAIM BEYOND THE
STATUTORY ONE YEAR FILING PERIOD:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________
______/_______/________
Signature of Claimant
Date
State of New York
County of _______________
On this ____________day of _______________20_________, before me, the undersigned Notary Public in and for the
State of ____________________personally appeared ___________________________________, personally known to
me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within
instrument and acknowledged to me that (s)he executed the same in his/her capacity and by his/her signature on the
instrument (s)he executed the instrument.
_____________________________
_______________________
Notary Public
Seal/Stamp
*I-55*
Alfred E. Smith State Office Building, 80 South Swan Street, Albany, NY 12210 │ 800-247-8035 │ovs.ny.gov
ANDREW M. CUOMO
ELIZABETH CRONIN ESQ.
Governor
Director
AFFIDAVIT IN SUPPORT OF LATE FILING OF OVS CLAIM
(TO BE COMPLETED BY CLAIMANT)
NAME : _____________________________________________ CLAIM NO:__________________
DATE OF CRIME: ____________________ LOCATION OF CRIME: _________________________
DATE REPORTED TO POLICE: _____________DATE CLAIM FILED WITH THE OVS:__________
DATE YOU WERE INFORMED OF THE OFFICE OF VICTIM SERVICES: _____________________
LIST THE FACTORS WHICH CAUSED THE DELAY IN FILING THE CLAIM BEYOND THE
STATUTORY ONE YEAR FILING PERIOD:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________
______/_______/________
Signature of Claimant
Date
State of New York
County of _______________
On this ____________day of _______________20_________, before me, the undersigned Notary Public in and for the
State of ____________________personally appeared ___________________________________, personally known to
me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within
instrument and acknowledged to me that (s)he executed the same in his/her capacity and by his/her signature on the
instrument (s)he executed the instrument.
_____________________________
_______________________
Notary Public
Seal/Stamp
*I-55*
Alfred E. Smith State Office Building, 80 South Swan Street, Albany, NY 12210 │ 800-247-8035 │ovs.ny.gov