Election Law 2475 - 508 General Form 43 (Petition for Voter Registration Confidentiality) 3/2018 In the Matter of a Proceeding Under Election Law 247 5 - 508 Docket No. PETITION FOR VOTER REGISTRATION CONFI DENTIALITY , Petitioner TO THE FAMILY COURT: The undersigned Petitioner respectfully shows, upon information and belief, that: 1. I am the named Petitioner in the above proceeding and am filing this petition in order to obtain an Order to the Board of Elections in [specify county]: to retain my voter registration records confidential pursuant to Election La w 247 5 - 508. 2. I am requesting voter registration record confidentiality because disclosure of my address or other 3. [Check applicable box(es)]: I h av e address confidentiality through the NYS Department of State, which expires on [specify date]: I have address confidentiality on my Family or Supreme Court case [specify name of case, docket or index number, court and status, if known]: I am residing in a domestic violence shelter. I am or my child(ren) is/are a victim of domestic violence committed by a family or household member as follows [explain]: 1 1 Election Law 2475 - 508(1) defines " Victim of domestic violence " as any person who defined in section 70.02 of the Penal Law, or disorderly conduct, harassment in the first or second degree, aggravated harassment in the second or third degree, stalking in the fourth degree, criminal mischief, mena cing in the second or third degree, menacing in the third degree, reckless endangerment, assault in the third degree or an (i) such act or acts have resulted in actual physical or emotional injury or have created a substantial risk of physical or emotional harm to such person or such person's child; and (ii) such act or acts are or are alleged to have been committed by a family or household member Family or household members (i) persons related by consanguinity or affinity; (ii) persons legally married to one another; (iii) persons formerly married to one another regardless of whether they still resi de in the same household; (iv) persons who have a child in common regardless of whether such persons are married or h ave lived together at any time; (v) persons who are not related by consanguinity or affinity and who are or have been in an intimate relationship regardless of whether such persons have lived together at any time. Factors the court may consider in determin ing whether a relationship is an "intimate relationship" include but are not limited to: the nature or type o f relationship, regardless of whether the relationship is sexual in nature; the frequency of interaction between the persons; and the duration of t he relationship. Neither a casual acquaintance nor ordinary fraternization between two individuals in business or social contexts shall American LegalNet, Inc. www.FormsWorkFlow.com GF - 43 Page 2 WHEREFORE, for the reasons stated above, I request that this Court issue an Order requiring that my voter registration record in the county of [specify]: that is kept or maintained in accordance with the Election Law be kept separate and apart from other voter registration records and not be made available for inspection or copying by the public or any other person except election officials acting within the course and scope of their duties and only as pertinent and necessary in connection with those duties; and that pending resolution of this petition, this Court issue an Order that this petition be kept confidential. Sworn to before me this , Notary Public (Deputy) Clerk of the Court Signature Print or type name Signature of Attorney (if any) American LegalNet, Inc. www.FormsWorkFlow.com