Form Trea-0607 - Signature Verification Form - Nyc Department Of Finance

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NYC DEPARTMENT OF FINANCE
TREASURY DIVISION
COURT
AND
SIGNATURE VERIFICATION FORM
TM
TRUST
Department of Finance
Mail to: NYC Department of Finance, Treasury/Court Assets, 66 John Street, 12th Floor, New York, NY 10038
Instructions: if you have not already signed and notarized the certificate of Deposit Application relating to your case,
as a payee named in the court order, you are required to complete, sign and have this form notarized. Payment cannot
be made until the payee's signature is verified. A disinterested notary must notarize all signatures. A certificate of au-
thenticity is required for notaries outside the State of New york. Submit the completed form to the address above. for
further information call 212-908-7619.
S I G N A T U R E C E R T I F I C A T I O N
( T O B E C O M P L E T E D B Y P A Y E E )
Payee Name: ___________________________________________
_______________________________________________
PriNt firSt NAme
PriNt lASt NAme
_________________________________________________________________________
Date: _______/_______/________
SigNAture of PAyee
Name of firm: ____________________________________________________________
____________________________
(if a corporation, individual owner or partnership):
PriNt firm NAme
PriNt NAme of corPorAte officer
Payee Address: ____________________________________________________________
Apt. #: ______________________
Number AND Street
city: __________________________________________ State: ______________________ Zip code: ____________________
N O T A R Y
Sworn to before me:
on this ______________ day of ________________________________, 20________, before me, the undersigned personally
appeared ____________________________ and _____________________________ and ___________________________
personally known to me, or proved to me on the within instrument and acknowledged to me that he/she/they executed the same
in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf
of which the individual(s) acted, executed the instrument.
Notary
Affix
Stamp
______________________________________________
Here
Notary Signature
T O B E C O M P L E T E D B Y F I N A N C E
cASe: ___________________________________________
A/c No: ______________________________________________ 
 

this office has received an order from: court: _____________________________ county: _______________________________
bearing name(s) of the claimant(s), payees or attorney where the order to pay for attorney: ___________________________________
____________________________
______/______/______
____________________________
______/______/______
i
cuStomer rePreSeNtAtive
S
NitiAlS
DAte
SuPerviSor
S iNitiAlS
DAte
Visit Finance at nyc.gov/finance
Trea-0607
Rev. 12.11.2015

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