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NYS Dept HealthCity Clerk NYCClick here to return to Town Website
Signature HereClick to Sign
05/28/2025Click to Sign

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

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Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

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Additional Signatures Required

REQUIRED: Please Upload Attachment(s) 1) PhotoID 2) * Notarized Document (if necessary) Please review instructions on page 1 to determine if you need to submit a notarized statement

Please attach a copy of Valid Photo ID(Passport or Driver's License or State Photo-ID) 


There is a 250MB limit on each attachment.

PHOTO ID Click Here to Upload
NOTARY STATEMENT(if mailing to PO Box or Third Party) Click Here to Upload