Grievances and Templates

Lawful Notice of Acceptance of Oath Template 

for NYC Public Officials (5 Boroughs). 

Please use this link to find the name and address to serve the Oath of Office acceptance. It is the directory of all the agencies and members of the NYC Administration.

NOTE: These templates are fillable customized PDFs and they are already in blue ink when completed. 

Both the certificate of service and the Notice require 2 witnesses.
Please Print in color and send via Certified Mail. 

Lawful Notice of Acceptance of Oath Template 

for State Public Officials 

NOTE: These templates are fillable customized PDFs and they are already in blue ink when completed. 

Both the certificate of service and the Notice require 2 witnesses.
Please Print in color and send via Certified Mail. 
These documents can be sent to your District Offices, Albany Offices or both.
www.nysenate.gov/find-my-senator
www.nyassembly.gov/mem/
New York State Assemblyman Template
New York State Senate Template

SF95 Form with Addendum

Click the icon on the top right of the document to download.

Sworn Statement – Affidavit of Harm Template

Click the icon on the top right of the document to download.