Misc. Forms/Downloads
Pistol Public Records Exemption Request
Active peace officers are exempt by law, therefore not effected by this provision. Retirees who wish to keep their gun ownership private should file for the exemption.
Click here to download
2013 UNUM Coverage Amendments
Click here to download
UNUM Application Form and Rate Chart
Unum Enrollment/Adjustment Application for Initial Application/Upgrade or Reduction of Coverage.
Click here to download
2013 Voluntary Reassignment Request
Complete and forward to address indicated on request. Also forward a copy to the association. All requests must be filed between December 1st and December 31st. Click here to download
2013 Vehicle Identification Request Form
Return via mail, fax, or email scanned copy no later than January 13, 2013. Complete form, print and sign, then attach photo-copy of registration.
Click here to view/download fillable form
2012 TD Bank Flyer
2012 Delegate and Trustees Election Results
Off Duty Application And Policy
Saint Joseph's College Flyer
St. Joseph's College program for any Full-Time NYS COURT CLERKS.
Click here to download
Mt Sinai Health Registry
9-11 FORM
9-11 form to send to retirement system.
Click here to download
New Co-Pay schedule

Co-pay schedule that will be put into effect slowly.
Click here to download
TD Bank Flyer

TD Bank Flyer for Chinatown branch.
Click here to download
Sick Leave Formula for Retirees
Retiree Pamphlet
Madison Planning Flyer
Veteran and Volunteer Fireman Form

You must fill out this form to get credit for veteran or volunteer fireman. You must get a confirmation for human resources that they received the form.
Click here to download


Update Member/Dependant Forms

Change of Address form
Beneficiary Change
Name Change Form
Change of Benefit Status



Reimbursement Claim Forms

Non-Participating Optical Reimbursement Form

Non-Participating Optical reimbursement form plus guideline for submitting request for payment.
Click here to download

Hospital Reimbursement Form

Please use this form for all Hospitalization claims.
Click here to download

Corrective Eye Surgery Reimbursement
Hearing Aid Reimbursement Form
Dental Claim Form

NYS Court Clerks Dental Form for active and retirees.
Click here to download
Sick Leave Bank Request