Delivery Confirmation

Justice Court Assistance Program
Delivery Confirmation

If your court was awarded items that would be shipped directly, please be sure to send the packing slips or sign the affirmation below for each item and promptly mail or fax them to:

Office of Justice Court Support
187 Wolf Road
Suite 103
Albany, NY 12205

Fax: 518 438-3518

Sometimes, orders contain multiple items that may not ship together. Please send in the packing slips and/or affirmations as the items arrive.

Thank you very much.

Court Name: __________________________ Affirmation
Quantity:	What was received: *	Print name:	Signature

Your signature affirms that the item(s) shown above were received.

Court Name: __________________________

Affirmation

Quantity:

What was received: *

Print name:

Signature

Your signature affirms that the item(s) shown above were received.

* Shredder, printing calculator, 4 drawer file cabinet, etc. Please be specific.