Ncfc Withdrawal Request Form - Nys Family Court

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NCFC 5/2013
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
1200 Old Country Road
Westbury, NY 11590
NCFC Withdrawal Request Form
This form may be used to request your custody, visitation, support, or guardianship petition be withdrawn.
This form will not be accepted to request a withdrawal on a family offense petition. You must appear in
person on your scheduled court date to request that your family offense petition be withdrawn.
The judge, support magistrate, or referee has the discretion to grant or deny this request.
Person Requesting Withdrawal:
Name:
Address:
Telephone #:
Case Information:
File #:
Docket #(s):
Date Petition Filed:
Petitioner’s Name:
Respondent’s Name:
Judge’s/Support Magistrate’s/Referee’s Name:
Court Date:
/
/
Reason for Withdrawal Request:
*
Sworn to before me this
*
Person Withdrawing Petition [sign name]
day of
, 20
Notary Public
*Note:
If you are submitting this request by mail or by fax, then it must be notarized.
Fax numbers for an individual NCFC judge, support magistrate, or referee can be found at
.
If you are submitting this request in person, notarization is not required, but you must show a
government issued photo identification.
Court use only
ID checked by:
(clerk’s initials)
Date:
/
/

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