Electronic Testimony Application Form (Page 2 of 2) in pdf

Form 4-24/ 5-16/UIFSA-10 Page 2

It would be an undue hardship for me to testify or to be deposed at the Family Court where the case is

scheduled to be heard for the following reason(s) [specify]: _________________________________

__________________________________________________________________________________

I am presently incarcerated at [specify facility]:

I will be

incarcerated on the date on which the hearing or deposition is scheduled and I am not expected to be

released until [specify approximate expected date of release]: _____________________.

4. I understand that prior to my application being granted, it is my responsibility to arrange a location for my

testimony or deposition with the Court. I request that I be permitted to testify or be deposed from the

following location [check applicable box and include all information]:

The Support Enforcement Agency in my County [specify the name, address and telephone number,

including area code]: ________________________________________________________________

The Court in my County [specify the name, address and telephone number, including area code]:

My attorney’s office [specify the name, address and telephone number, including area code]:

__________________________________________________________________________________

_______________________________________________________________________.

Other location [specify name. address and telephone number, including area code]:

I am requesting this location because [state reason]:

5. I understand that I must confirm final arrangements for testifying by electronic means with this Court by calling

the telephone number that will be provided to me. I further understand that the Court will send me a written Order

telling me whether this application has been granted or denied and what number I should call to confirm.

Please transmit this order by [check box]:

e-mail

facsimile as indicated on the first page of this form.

6. I understand that I have the right to discuss this matter with legal counsel. By this application, I am consenting to

the hearing and determination of this matter by this Court without my physical presence.

7. I understand that I have the right to be present at any and all appearances, including any hearing scheduled by the

Court. I understand that if I fail to appear on any of the scheduled dates, either in person or by telephone, audio-

visual means or other electronic means approved by this Court, this Court may hear the matter in my absence or may

issue a WARRANT for my arrest. If I am the Petitioner, I understand that if I fail to appear, either in person or by

telephone, audio-visual means or other electronic means approved by this Court, the Court may DISMISS my

petition.

8. I understand that I must forward to the Court, prior to my scheduled appearance, the completed financial

documentation as requested in the attached summons, as well as proof of identity.

WHEREFORE, for the reasons stated above, I respectfully request that this application be granted.

Dated:________________________.

________________________________________

Respondent

Petitioner

Witness

Electronic Testimony Application Form Page 2