Ticket Seller Non-Nyc Resident Form - Nyc Department Of Consumer Affairs

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42 Broadway
TICKET SELLER
Lobby
New York, NY 10004
NON-NYC RESIDENT FORM
Dial 311
(212-NEW-YORK)
Complete this form if you do NOT reside in New York City.
nyc.gov/consumers
License Applicant Name:
Additional Names Used
(if any):
Current Home Address:
You must provide below the name and address of someone who resides
in New York City who can accept service of legal documents on your
behalf. Note that you may designate the Commissioner of the
Department of Consumer Affairs for this purpose. Please check one of
the boxes below.
I designate the following person:
Name:
Address:
I would like to designate the Commissioner of the Department
of Consumer Affairs upon whom process or other notification
may be served.
I understand that falsification of any statement made herein is an offense
punishable by a fine or imprisonment or both.
________________________________________
________________________________________
Signature
Print Name
________________________________________
________________________________________
Title/Position (if any)
Date
06/22/2016

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