Prepare a proposed Order Settling Final Account (see sample). FORM. TITLE. PDF. FILLABLE. HELP. 8. Notice of Petition, Petition, Verification in a Special Proceeding.Dear Ms. Harper: Please accept this letter as a request for payment under the Sick Leave Bank. I am requesting time due to an illness. Is there a residential rental agreement? No. Complete the: 1. Mail the completed forms to the appropriate Nassau County Health. Department Bureau as indicated in the covering letter. Please ensure it is filled out completely, signed and notarized. (13) Signatures: Please ensure the application is filled out completely.