Affidavit Of Plaintiff - Supreme Court Of The State Of New York (Page 8 of 9) in pdf

Affidavit Of Plaintiff - Supreme Court Of The State Of New York Page 8

 Plaintiff’s OR  Defendant’s prior surname is:

Pursuant to DRL § 240 1 (a-1) Records Checking Requirements:

 An Order of Protection  has been  has never been issued against me, enjoining me or requiring my

compliance.

 An Order of Protection  has  has never been issued in favor of or protecting me or my child(ren)

or a member of my household.

List all Family/Criminal Court Docket #’s and Counties,

____________________________

Supreme Court Index #’s and Counties

____________________________

 I or my child(ren) or my spouse has been named in a Child Abuse/Neglect Proceeding (FCA Art.10)

List all Family Court Docket #’s

____________________________

and Counties

____________________________

 I or my child(ren) or my spouse has never been named in a Child Abuse/Neglect Proceeding (FCA

Art.10)

 I am registered under New York State’s Sex Offender Registration Act

List all names under which

____________________________

you are registered

____________________________

 I am not registered under New York State’s Sex Offender Registration Act

WHEREFORE, I

(print name), respectfully request that

judgment be entered for the relief sought and for such other relief as the court deems fitting and proper.

Subscribed and Sworn to

before me on

Plaintiff’s Signature

NOTARY PUBLIC

(Form UD-6 Rev. 1/13)

Affidavit Of Plaintiff - Supreme Court Of The State Of New York Page 8