Claimant to select the appropriate forms for the situation:
Claims for $250.01 to $5,000 (Form C3518-1290)
Claims for $250 or less (Form C3519-1290)
Claimant to complete two (2) sets of forms, as two sets with original signatures are required by the State University of New York (SUNY) for their processing purposes.
Portions to be completed by claimant are:
Page 1 – Claim form – the affidavit of the claim form. Fill in name, address and dollar amount of claim. DO NOT SIGN until instructed to do so by a notary public.
Page 2 – Release form – first paragraph of the release form. Fill in the dollar amount of claim, the name of the person/vendor that the payment should be made to and address of person/vendor. DO NOT SIGN until instructed to do so by a notary public.
Notary public to notarize the claim and release forms where indicated. There will be a total of four (4) notarizations to complete the claim, as two sets of forms with original signatures are required by SUNY.
Claimant to return two original sets (completed and notarized forms) with supporting documentation, i.e., police report, receipts, etc., to the Office of Finance and Management. If the claim involves repairs to damaged property, such as automobiles, two estimates for such repairs must be included.
Return the completed forms to:
SUNY Brockport
Office of Finance and Management
506 Allen Administration Building
Brockport NY 14420-2967
For assistance, please feel free to contact Crystal Hallenbeck-McPhall at challenb@brockport.edu or call 585-395-2393.
