Affidavit In Support Of Application To Proceed As A Poor Person - New York Supreme Court Page 2
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73) I have attached a copy of the documents I intend to file for your review
[8. Check one and attach document]
Summons and Complaint
Notice of Petition & Petition
Summons with Notice
Affidavit
Other
4) I have income in the following amounts from the following sources[9. State all of
your current income including child support, public assistance and any other income]
Source
Amount
Monthly/Weekly
[10. Attach all proof of income-paystubs, child support checks, social services
statements]
5) I have no income that is not listed above.
6) Check one of the items below: [11. Provide bank account information.]
I do not have a bank account
I have a bank account(s) with approximately $
on deposit.
7) I own the following property which has an estimated value above $300.00
[12. List all property including real estate, vehicles and items of personal property
worth more than $300.00]
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