Smithtown, NY · Suffolk County
Board of Health Affidavit
This affidavit is completed by a property owner or authorized agent who has applied to the Suffolk County Department of Health Services, and is filed with Smithtown’s Building Department.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The affidavit states that the owner or authorized agent has applied to the Suffolk County Department of Health Services and asks that the department receive the Board of Health filing receipt when available. It also acknowledges that Smithtown will not issue a certificate of occupancy until final Board of Health approval is submitted to the Building Department. The form says it is not valid for new single-family dwellings.
Who needs it
A property owner or authorized agent who has applied to the Suffolk County Department of Health Services and needs to provide Smithtown’s Building Department with the affidavit.
How to get this notarized
- 1
Download the Affidavit
Get the Board of Health Affidavit from the Town of Smithtown.
- 2
Fill In the Form
Enter the owner or agent name and property address. Do not sign before your notary appointment.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign on Video
Show identification and sign when directed during the video session.
- 5
Submit to the Building Department
Send the notarized affidavit to Smithtown’s Building Department and provide the Board of Health filing receipt when received.
Preview the form
The blank PDF straight from Smithtown. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I notarize the Board of Health Affidavit online?
- Complete the form, book a session with a commissioned online notary, and sign during the video meeting. Submit the notarized affidavit to Smithtown’s Building Department.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes a jurat stating that it was sworn and has a notary signature and stamp area. Sign before the notary during your appointment.
- Can I use this affidavit for a new single-family dwelling?
- No. The form states that the affidavit is not valid for new single-family dwellings.
- Does the affidavit replace final Board of Health approval?
- No. The form says Smithtown will not issue a certificate of occupancy until final Board of Health approval is submitted to the Building Department. Confirm with the city, town or village if unsure.
- Can a commissioned online notary notarize this form?
- New York authorizes remote online notarization by its own notaries under Executive Law §135-c, effective since 2023. Confirm that the receiving department accepts your notarized document.