Filing By Fax Cover Sheet

New York State Court of Claims - Filing by Fax Cover Sheet (complete, print form, and fax with paper to be filed) Pursuant to Section 206.5 - A of the Uniform Rules, the clerk shall not be required to accept a filing if it is more than 50 pages in length (including exhibits, but excluding the cover sheet). Date: Claimant(s): Claim Number (if any): Paper Being Filed: Name and Address of Filing Party or Attorney: Telephone Number of Filing Party or Attorney: Fax Number of Filing Party or Attorney: Total Number of Pages of this Transmission, including Cover Page: FOR CLAIM FILINGS ONLY If you are filing a claim, you must either pay the $50.00 filing fee by completing the credit card authorization, or make an application for a waiver or reduction of the filing fee by submitting the appropriate affidavit. CREDIT CARD AUTHORIZATION l, authorize the New York State Court of Claims to charge my credit card for the $50.00 filing fee required for filing the above claim. Ma ster Card Discover Card Visa Cardholder Name Cardholder Signature Credit Card Number Expiration Date FAX to: 866 - 413 - 1069 (toll - free) 6 / 15/18 American LegalNet, Inc. www.FormsWorkFlow.com