This is a form for which you can submit a petition challenging the seizure of cannabis or other related items by the Office of the Sheriff of the City of New York or a designee of such Sheriff pursuant to section 42-04(g) of title 19 of the Rules of the City of New York. You may also use this form to submit a petition challenging an order to cease prohibited conduct pursuant to such rule. Please fill out all relevant fields. You may submit your petition in the field entitled “petition/comments” or you may attach your petition and any supporting documentation below.

 
 
 
 
Tracking Number
 
 
 
 
Date on Order to Cease Unlawful Conduct / Notice of Seizure
 
 
 
 
 
 
 
Business Information
 
 
 
 
Business Name*
 
 
 
Business Street Address*
 
 
 
 
Business Street Address 2
 
 
 
City*
 
 
State*
 
 
Zip code*
 
 
 
 
 
Petitioner's Information
 
 
Petitioner's First Name*
 
 
Petitioner's Last Name*
 
 
 
Street Address
 
 
Apt/Fl/Suite/Room
 
 
 
City, State and Zip Code
 
 
 
Email Address*
 
 
Phone Number*
 
 
 
 
Petition/Comments*
 
 
 
 
 
Upload supporting documentation (optional)