Form Ucs-840m - Matrimonial Request For Judicial Intervention Addendum
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U C S -840M
MATRIMONIAL
Request for Judicial Intervention Addendum
3/2011
Supreme
Yates
________________________
________________________
___________________________
COURT, COUNTY OF
INDEX NO.
For use w hen there are children under the age of 18 w ho are subject to the matrimonial action.
Plaintiff
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
Gender: G Male
G Fem ale
Prior Names
:
(List any other names used, including maiden and/or former married names)
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
New York
Present Address: ________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Address History
Wyoming
for past 3 years
:
________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Wyoming
________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Wyoming
________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Defendant
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
Gender: G Male
G Fem ale
Prior Names
:
(List any other names used, including maiden and/or former married names)
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
New York
Present Address: ________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Address History
Wyoming
for past 3 years
________________________________________________________________________________________
:
(Street Address)
(City)
(State)
(Zip)
Wyoming
________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Wyoming
________________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip)
Children
Gender: G M G F
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
Gender: G M G F
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
Gender: G M G F
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
Gender: G M G F
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
Gender: G M G F
Last Name: _________________________ First Name: _________________________
Date of Birth: ________________
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Parent category: Legal