Affidavit In Support Of Modification Of Family Court Order Of Protection Or Temporary Order Of Protection
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Affidavit In Support Of Modification Of Family Court Order Of Protection Or Temporary Order Of Protection Form. This is a New York form and can be use in Family Court Statewide.
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Tags: Affidavit In Support Of Modification Of Family Court Order Of Protection Or Temporary Order Of Protection, GF-5d, New York Statewide, Family Court
FCA '154-d; CPL ''530.12 (3),(3-a),(3-b)
(Local Criminal Court):
County of
_____________________________
Petitioner
Family Court General Form 5d
Criminal Form 5
9/2009
AFFIDAVIT IN SUPPORT OF
MODIFICATION OF FAMILY COURT
ORDER OF PROTECTION
TEMPORARY ORDER OF PROTECTION
Index/Docket #
Respondent
_______________________________
State of New York )
): ss:
County of
)
I, (Petitioner's name):__________________________________, having been duly sworn,
depose and state the following under the penalties of perjury:
1. The Family Court, _______________________ County, is not in session at the present
time.
2. I filed a petition under [specify article]: _________ of the Family Court Act in
Family Court, ____________________ County, on [specify date]: __________. The Family
Court issued an order of protection a temporary order of protection that expires on [specify
date]: _____________________.
3. The following criminal, matrimonial or Family Court cases have been filed involving the
respondent and me: [Specify type of case, who filed it, the court in which it was filed, the approximate
date filed and the present status, if known]:
4. The following additional orders of protection or temporary orders of protection have
been issued against the Respondent or against me: [Specify type of case in which the order was issued,
persons protected by the order, the court that issued it, the approximate date issued and expiration date,
if known]:
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Family Court General Form 5d/Crim Form 5 Page 2
5. I understand that any modification of the Family Court order issued by this Court shall
expire on the date indicated, which shall be not more than four calendar days after its issuance, unless
sooner vacated or modified by the Family Court. I understand that the matter will be transferred to the
Family Court and that I must appear in Family Court on or before the date indicated. I further
understand that I have a right to seek a criminal prosecution of respondent in addition to, or instead of,
proceeding in Family Court.
6. The following constitutes good cause for modifying the temporary order of protection or
order of protection: [Specify facts and reasons why the existing order is insufficient for the protection
of the petitioner, the petitioner's child or children or other members of the petitioner's family or
household]:
For the reasons stated above, I am requesting that my application for modification of the
Family Court Qtemporary order of protection Qorder of protection be granted and that the matter be
transferred to the Family Court, ____________________County.
False statements in this affidavit are punishable as a class A misdemeanor, pursuant to Penal
Law '210.45.
_____
Petitioner
Sworn to before me
this day of
_________________________
(JUDGE):
(SUPERIOR OR DESK OFFICER, POLICE DEPARTMENT):
(NOTARY PUBLIC):
TO CLERK OF COURT:
This affidavit, together with any modified order of protection or temporary order of
protection so issued, shall be transmitted forthwith to the Family Court; if the affidavit and order are
transmitted by facsimile or other electronic means, the original shall be forwarded immediately
thereafter.
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