This form contains 30 fields organized into 8 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Affiant (Server) and Sworn County
Name of Server (Affiant)	Text	Enter the full name of the person who served the papers (the affiant/server) who is swearing to this affirmation.
County	Text	Enter the name of the county in New York where the affidavit is being sworn.
Affirmation Date
Affirmation Month	Text	Enter the month name or abbreviation when the affirmation was made (e.g., January or Jan).
Affirmation Year	Text	Enter the year of the affirmation (e.g., 2026 or the digits that complete '20__').
Affirmation Day	Text	Enter the day of the month when the affirmation was made (e.g., 3 or 15).
Court and Case Identifiers
County	Text	Enter the name of the county where this case is filed (for example: Bronx, Kings, New York).
Index Number (L&T)	Text	Enter the court index or docket number assigned to this landlord-tenant case.
Petitioner / Landlord Name(s)	Text	Enter the full name(s) of the petitioner(s) or landlord(s) bringing the action; include business or company name as applicable.
Name of Person Making Affirmation	Text	Enter the full name of the individual who is completing and signing this affirmation of service (the affiant/server).
Description of Individual Served
Other Identifying Features	Text	Enter any scars, tattoos, marks, clothing, or other distinguishing details that help identify the individual served.
Color of Skin	Text	Enter the individual's skin color or complexion (for example, 'light', 'medium brown', or 'dark').
Approximate Weight	Number	Enter the individual's approximate weight.
Color of Hair	Text	Enter the individual's hair color (for example, 'black', 'brown', 'gray', or 'bald').
Approximate Height	Text	Enter the individual's approximate height and any notable build characteristics (for example, '5 ft 8 in, medium build').
Sex	Text	Enter the individual's sex as observed (for example, 'Male' or 'Female').
Approximate Age	Text	Enter the individual's approximate age in years (for example, '45').
Papers Served and Person Papers Left With
Type of Paper(s) delivered	Text	Enter the name(s) or title(s) of the document(s) personally delivered to the respondent (for example, "Summons and Complaint").
Date of service	Date	Enter the date on which the papers were served.
Type of Paper(s) (attached)	Text	Enter the title(s) or short description(s) of the attached document(s) that were served in this matter.
Additional attached paper(s) / identifier	Text	Enter any additional short title, identifier, or brief description of other attached paper(s) referenced on this line.
Parties (Landlord and Respondents)
Respondent(s)-Undertenant(s)	Text	Enter the full name(s) of any respondent(s) who are undertenant(s) or additional parties related to the tenancy.
Petitioner-Landlord	Text	Enter the full name of the petitioner or landlord (individual or business) who is bringing the action.
Respondent(s)-Tenant(s)	Text	Enter the full name(s) of the respondent(s) or tenant(s) against whom the action is brought.
Server Signature Block
Server Signature	Text	Enter the server's handwritten or typed signature to attest to the truth of the affirmation.
Printed Name of Server	Text	Enter the full printed name of the person who served the papers.
Date of Signature	Date	Enter the date when the server signed this affirmation.
Service Date/Time and Location
County of Service	Text	Enter the name of the county in which the service took place.
Service Address	Text	Enter the full street address where the person was served, including apartment or unit if applicable.
Service Date	Date	Enter the date on which the papers were personally served.
Service Time	Time	Enter the time when the papers were personally served.

Affirmation of Service (New York) (January 2024) Instructions