Consent To Witdraw Appeal Affidavit (PINS)
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Consent To Witdraw Appeal Affidavit (PINS) Form. This is a New York form and can be use in Appellate Division Appellate Courts.
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Tags: Consent To Witdraw Appeal Affidavit (PINS), New York Appellate Courts, Appellate Division
STATE OF NEW YORK
FAMILY COURT:__________________ COUNTY
___________________________________________
In the Matter of
CONSENT TO WITHDRAW
APPEAL AFFIDAVIT
_______________________,
A Person Alleged to be a Person
In Need of Supervision,
Docket No.
Respondent.
___________________________________________
STATE OF NEW YORK
COUNTY OF
TOWN OF
)
) SS:
)
____________________________, being duly sworn deposes and says:
1.
That your deponent is the Respondent in the above-entitled action.
2.
That I have thoroughly discussed my case with my attorney,
__________________________________, ESQ.
3.
That I understand that HONORABLE ________________________________,
________________________ County Family Court Judge, has lifted one of the restrictions of
my twenty-four hour supervision so that the treatment agency may work with me.
4.
That I no longer wish to appeal the Order of _____________________, entered
on the ______day of ______________, _____, a copy of which is attached hereto and marked
Exhibit A, and hereby consent to the withdrawal of my appeal.
_____________________________
Sworn to before me this
____ day of
, 20___.
_____________________________
Notary Public
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