Affirmation of Service (New York) (January 2024) Completed Form Examples and Samples
Explore free, filled-out examples and samples of the official New York Affirmation of Service form (January 2024 version). Our detailed templates, including scenarios like divorce filings, guide you on how to correctly complete the proof of service for NY courts.
Affirmation of Service (New York) Example – Personal Delivery in a Divorce Case
How this form was filled:
This is a filled-out example of a New York Affirmation of Service form (January 2024 version). This sample illustrates how a process server would affirm that they personally delivered a Summons and other initial divorce papers to the defendant at their residence. It includes all necessary details such as court information, party names, index number, and the specific date, time, and location of service.
Information used to fill out the document:
- Court: Supreme Court of the State of New York
- County: Kings
- Index Number: 12345/2026
- Plaintiff: Jane Smith
- Defendant: John Smith
- Affiant (Process Server): Michael Chen
- Affiant Status: Not a party to the action, over 18 years of age
- Documents Served: Summons with Notice, Notice of Automatic Orders, Notice Concerning Continuation of Health Care Coverage
- Date of Service: February 10, 2026
- Time of Service: 3:15 PM
- Place of Service: 456 Oak Avenue, Brooklyn, NY 11201
- Method of Service: Personal delivery to the defendant
- Person Served: John Smith, the Defendant
- Description of Person Served: Male, Caucasian, approx. 40 years old, 6'0", 180 lbs, brown hair, blue eyes
- Affiant's Address: 789 Pine Street, Brooklyn, NY 11231
- Date of Affirmation: February 11, 2026
What this filled form sample shows:
- Accurately identifies the court, county, and index number for the legal action.
- Clearly states the names of the plaintiff and defendant.
- Details the specific date, time, and precise location of the service.
- Specifies the method of service as personal delivery to the defendant.
- Includes a physical description of the individual who was served.
- Properly dated and signed by the affiant under penalty of perjury as required by New York law.
Form specifications and details:
| Form Name: | Affirmation of Service |
| Form Version: | January 2024 |
| Jurisdiction: | New York State |
| Use Case: | Personal delivery of initial pleadings in a matrimonial (divorce) action. |
Created: January 31, 2026 01:35 AM
