Affidavit In Support Of Application To Proceed As A Poor Person - New York Supreme Court Page 7
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7SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
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[29. Index No. & Year]
,
Index No.
[30. Fill in name(s)]
Plaintiff(s)
/
-against-
,
[31. Fill in name(s)]
Defendant(s)
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[32. Insert name(s) of papers submitted]
[33. YOUR SIGNATURE]
[34. PRINT YOUR NAME]
[35. YOUR ADDRESS]
[36. CITY, STATE ZIP CODE]
[37. YOUR PHONE NUMBER]
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