Affidavit Of Plaintiff - Supreme Court Of The State Of New York (Page 3 of 9) in pdf

Affidavit Of Plaintiff - Supreme Court Of The State Of New York Page 3

Yes  No 

marriage (see definition on page 7 of the Instructions) in this or another state.

I have information of a custody proceeding concerning the minor child(ren)of the marriage (see

definition on page 7 of the Instructions) pending in a court of this or another state. Yes  No 

I know of a person who is not a party to this proceeding who has physical custody of the minor

child(ren) of the marriage (see definition on page 7 of the Instructions) or claims to have custody

or visitation rights with respect to such child(ren). Yes  No 

The parties are covered by the following group health plans:

Plaintiff

Defendant

Group Health Plan:

Address:

Identification Number:

Plan Administrator:

Type of Coverage:

 Not Applicable.

 No health plans are available to the parties

through their employment

5. The grounds for dissolution of the marriage are as follows:

Cruel and Inhuman Treatment (DRL §170(1)):



At the following times Defendant committed the following act(s) which endangered the

Plaintiff’s physical or mental well being and rendered it unsafe or improper for Plaintiff to

continue to reside with Defendant.

(State the facts that demonstrate cruel and inhuman conduct giving dates, places and specific acts. Conduct

may include physical, verbal, sexual or emotional behavior.)

(Attach an additional sheet, if necessary)

(Form UD-6 Rev. 1/13)

Affidavit Of Plaintiff - Supreme Court Of The State Of New York Page 3