Annual Certification of Approved Uses

This page was last updated on May 4, 2026.

To qualify for settlement funds, please fill out the following form.

(Name of Recipient Entity) hereby certifies that it will use the funds it receives from Juul's June 2026 payment for the sole purpose of remediating the harm caused by e-cigarette use, consistent with Paragraph 52 of the consent order and judgement in State of New York v. JUUL Labs Inc., et. al. (Index No.: 452168/2019), approved by the Supreme Court of the State of New York on April 21, 2023. These funds will not replace (supplant) existing local, state, or federal funding.

If you would prefer to fill out a hard copy of this form, please download and send the signed form to:

Attn: Annette Navarro
28 Liberty Street
23rd Floor
New York, NY 10005

or email to annette.navarro@ag.ny.gov