Affidavit In Support Of An Application To Proceed As Poor Person And For State To Pay For Transcript
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Affidavit In Support Of An Application To Proceed As Poor Person And For State To Pay For Transcript Form. This is a New York form and can be use in New York Local County.
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Tags: Affidavit In Support Of An Application To Proceed As Poor Person And For State To Pay For Transcript, CIV-GP-16, New York Local County, New York
CIVIL COURT OF THE CITY OF NEW YORK
County of
Part
in the matter of the Application of
Index No.:
AFFIDAVIT IN SUPPORT OF
AN APPLICATION TO PROCEED
AS A POOR PERSON
AND AUTHORIZING THE STATE
TO PAY THE COSTS
FOR THE PRODUCTION OF
A STENOGRAPHIC TRANSCRIPT
to prosecute as a poor person against
State of New York, County of
ss:
, being duly sworn, deposes and says:
in the above titled action.
1. I am the party named as
2. The case was tried before Judge
.
3. 1 request that an Order be granted:
AUTHORIZING THE STATE TO PAY THE COSTS FOR THE STENOGRAPHIC TRANSCRIPT.
The estimate* of the costs for the production of the transcript is $
[*Attach estimate(s) and total them if more than one.]
If no Notice of' Appeal is to be filed, but a request for the State to pay the costs for the production of a transcript is being submitted,
please state why the transcript is needed
.
4. 1 make this application based on CPLR ยง1101. I do not have, nor am I able to obtain, the funds needed to file a
Notice of Appeal and/or to pay for the stenographic transcript. I will be unable to proceed unless the Order is granted.
5. 1 am/am not a recipient of Public Assistance from the Department of Social Services of the City of New York.
(strike one).
per
6. 1 have no income other than the sum of $
from
.
7. 1 own no property of any kind except necessary personal wearing apparel and
.
8. No other person is beneficially interested in the recovery sought.
a) I have not made a previous application for this or similar relief
9.
b) I have made previous application(s) for this or similar relief, but I am making this further application
because
Sworn to before me this
day of
20
Sign your name
Print your address
Signature of Court Employee and Title
Telephone Number
CIV-GP-16-i (Revised 1/04)
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