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The New York Poor Person form is a legal document that allows individuals to request permission to appeal a family court decision without incurring the costs typically associated with such proceedings. This form is essential for those who cannot afford legal fees and seek to have an attorney assigned to them. Understanding how to correctly fill out and submit this form is crucial for ensuring access to justice.

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The New York Poor Person form serves as a crucial document for individuals seeking to appeal a family court decision without the financial means to afford legal representation. This form is essential for those wishing to request permission to proceed as a poor person and to obtain an assignment of counsel for their appeal. At the top of the form, a Notice of Motion must be filled out, including the case title and specific dates related to the notarization of the affidavit and the return date of the motion. It is important to serve the motion papers to all involved parties, including attorneys and the County Attorney, ensuring that proper procedures are followed. The form requires detailed information about the nature of the proceeding, the judgment being appealed, and the applicant's financial situation. Additionally, the affidavit in support of the motion asks for personal details, including employment status and any support received, which helps establish the necessity for poor person status. Importantly, the process does not involve oral arguments on the return date, streamlining the review of the application. Completing this form accurately is vital for those who wish to navigate the legal system despite financial constraints.

The New York Poor Person form is designed to assist individuals seeking to appeal a court decision without the financial means to afford legal representation. Several other documents serve similar purposes in different contexts. Below are five such documents, along with their similarities to the New York Poor Person form:

Application for Waiver of Fees: This document allows individuals to request a waiver of court fees based on financial hardship. Like the Poor Person form, it requires detailed financial information to demonstrate the applicant's inability to pay.
Affidavit of Indigency: This affidavit is used to declare an individual's financial status, asserting that they cannot afford legal costs. Similar to the Poor Person form, it necessitates a sworn statement regarding income and expenses to support the claim of indigency.
Motion for Appointment of Counsel: This motion requests the court to assign an attorney to a party who cannot afford one. It shares a common goal with the Poor Person form, as both aim to secure legal representation for those lacking financial resources.
Financial Disclosure Statement: Often required in family law cases, this statement provides a comprehensive overview of an individual's financial situation. Like the Poor Person form, it aims to assess the ability to pay for legal services and court fees.
Request for Pro Bono Representation: This request seeks free legal assistance from lawyers willing to volunteer their services. It parallels the Poor Person form by addressing the need for legal help without the means to pay for it.

STATE OF NEW YORK

SUPREME COURT, APPELLATE DIVISION

THIRD JUDICIAL DEPARTMENT

P.O. BOX 7288, CAPITOL STATION

ALBANY, NY 12224

INSTRUCTIONS FOR MOVING FOR PERMISSION TO PROCEED

AS A POOR PERSON AND FOR ASSIGNMENT OF COUNSEL ON A FAMILY COURT APPEAL

1)At the top of the attached form is a Notice of Motion. The title of the case should be placed on the left hand side of the form and it should be written as the title appeared on the order or judgment appealed from. This is the caption. Below the caption is a sentence which begins "Please take notice...". The first date to be filled in is the date the attached affidavit in support of the motion was notarized. The second date to be filled in is the return date of the motion, which should be a Monday after service of the motion papers upon all parties as described in paragraph 2 below.

2)The motion papers should be served on all parties (if a party is represented by an attorney, service of a copy should be made upon the attorney and if a party is represented by the Office of the Attorney General, service of a copy should be made upon that office), and on the County Attorney of the County in which the papers from the lower court were filed and any Attorney for the Child. If service of the motion papers is done by personal delivery, the motion should be made returnable on a Monday at least eight (8) days after such service. If service of the motion papers is done by mail, the motion should be made returnable on a Monday at least thirteen (13) days after the motion papers are mailed.

3)As soon as possible after service of copies of the motion papers, the original motion papers, as well as proof that you have served the motion papers on the other parties, the County Attorney and the Attorney for the Child, should be forwarded to this office. If the motion is being made in connection with an appeal to this Court, you should also attach to the motion papers a copy of the order or judgment being appealed from, the decision, if any, upon which the order or judgment was based, and a copy of the notice of appeal.

4)THERE WILL NOT BE ORAL ARGUMENT ON THE RETURN DATE OF THE MOTION.

Revised:

February 19, 2014

Please fill in the underlined spaces in the follow ing form. Return the original to this Court, forward one copy to each of your adversaries, forward one copy to the County Attorney, one copy to the Attorney for the Child and keep one for your records.

STATE OF NEW YORK		SUPREME COURT
APPELLATE DIVISION		THIRD DEPARTMENT
IN THE MATTER OF
			,
	Petitioner(s) ,
v
	,

	Respondent(s) .

NOTICE OF

MOTION FOR PERMISSION TO PROCEED AS A POOR PERSON/ ASSIGNMENT OF COUNSEL ON APPEAL OF AN ORDER OF FAMILY COURT

Family Court

Docket No./ Index No.:

Appellate Division

Case No.

PLEASE TAKE NOTICE that, upon the annexed affidavit sworn to on the		day of
, 20	, a motion will be made to this court, on the	day of
, 20	, a motion will be made to this court, on the	day of

,20 , in the City of Albany New York, for an order

granting the appellant permission to appeal as a poor person.

Dated:

(Signature)

(Print Name)

(Address)

(Your name, address and telephone number)

DIN # (if applicable)

(Telephone)

PLEASE TAKE NOTICE that, pursuant to section 800.2 (a) of the Rules of this Court, this motion will be submitted on the papers, and the personal appearance of counsel or the parties is neither required nor permitted.

Revised:

February 19, 2014

AFFIDAVIT IN SUPPORT OF MOTION

STATE OF NEW YORK

COUNTY OF		ss.:

, being duly sworn, deposes and says

that I make this affidavit in support of my application for poor person status and assignment of counsel.

1.My full name and date of birth is:

2.What is the nature of the above entitled proceeding?

3.	I am appealing from a judgment/order of		Court,		County,

which provides as follows:

(Please attach hereto a copy of the order or judgment appealed from, the decision, if any, upon which the order or judgment is based, and a copy of your notice of appeal.)

4.	a.	An order or judgment has been entered in the			Court Clerk’s

	Office on		, 20	.

	b.	A copy of that	order or judgment was served on me on		, 20	.

c.Have you filed an original and two copies of any notice of appeal with the Clerk of the

appropriate court?	Yes	No
If yes, when?
If yes, when?

d.If yes, have you served a copy of the notice of appeal on your adversaries and the

attorney for the child?		Yes	No
If yes, when?
If yes, when?

e.	Were you represented by counsel?			Yes	No
	Counsel's name and address:
	Counsel's name and address:
	(if applicable)
	(if applicable)

Revised:

February 19, 2014

f.	Was counsel assigned or retained?	Assigned		Retained

5.If you were represented by retained counsel in the court below, state the name and address of the person who paid his/her fee and the amount.

6.What relief are you seeking by this motion?

7.What facts are present to support your contention that there is merit to your appeal? (Attach additional documentation, if necessary.)

8.Are you able to pay the costs, fees and expenses necessary to maintain the appeal?

YesNo

9. Are youSingleMarriedSeparatedDivorced

If married, what is the name of your spouse?

What are the first names and ages of your children?

Revised:

February 19, 2014

10.What is your occupation? If you are a student, indicate the school which you attend and the name and address of the person who is paying your tuition, room and board.

11. Are you are employed?	Yes		No		If yes, please state your weekly salary and

provide the name and address of your employer. Please provide a copy of your most recent pay

stub.

12.If married and your spouse is employed, what is his/her weekly gross salary and the name and address of his/her employer?

13. Do you receive support from anyone? Yes		No		If yes please provide the name,

relationship, address and the amount of support provided to you.

Revised:

February 19, 2014

14. Do you support anyone? Yes	No	If yes, please provide the name, relationship,

address and the amount of support you provide.

15. Do you own real estate either by yourself or with someone else? Yes		No
If yes please provide the following information:
If yes please provide the following information:

a.Other owner(s) (if any):

b.Location (street address, mailing address; Town, County, State):

c.Current value, including improvements:

d.Existing mortgages and/or liens (Attach additional sheet if required):

1.Name of bank, mortgagee or lien holder:

2.Balance due:

16.List the location and amount of any savings or checking accounts held in your name or jointly with others (Attach additional sheet if required):

Revised:

February 19, 2014

17.List any stocks, bonds, trusts or cash on hand owned by you in which you have any benefit and give the type, location and value of each (Attach additional sheet if required):

18.Please state the year, make model and value of any motor vehicle(s) owned by you and the amount of any existing loan(s):

19. Do you own any other assets not listed above? Yes		No

20.If yes please describe the assets(s) and state the value (Attach additional sheet if required):

21.My monthly income and expenses are as follows:

INCOME: My salary

My spouse's earnings Other income

TOTAL

EXPENSES:

Rent or mortgage payment

Food

Utilities (heat, telephone, water, electric, cable)

Automobile expenses

Premiums on life or medical insurance policies

Repayment of loans

Name of creditor and amount

Other obligations, including alimony /support

TOTAL

Revised:

February 19, 2014

22. Is any other person beneficially interested in any recovery sought herein?		Yes	No

If so, is such person able to pay the costs, fees and expenses of maintaining the appeal?
Yes	No

23.Do you authorize the Court to make any inquiries or investigation concerning the answers given

to you in this affidavit?	Yes		No

24.Did someone else complete this form on your behalf?

Yes No

25.If "yes" to question 24, were the questions and answers read to you and are your

answers true?	Yes		No

(Signature) (Print Name)

Sworn to before me this

day of		,	.


	Notary Public

Revised:

February 19, 2014

	AFFIDAVIT OF SERVICE OF MAILING
STATE OF NEW YORK	)
COUNTY OF		) ss.:

, being duly sworn, deposes and says:

On the		day of	, 20			, I served a true copy of the

annexed notice of motion and supporting affidavit by mailing the same in a sealed envelope, with

postage prepaid thereon, in a post office or official depository of the U.S. Postal Service within the

State of New York, addressed to the last known addressee(s) as indicated below:

(Insert here the name[s] and address[es] of the person[s] to w hom you are mailing the papers being filed with this Court. If necessary, attach extra pages for additional nam es and addresses.)

Name & Address

(Signature)

(Print Name)

Sworn to before me this

day of	,	.

Notary Public

Revised: February 19, 2014

Filling out the New York Poor Person form can be straightforward, but mistakes can lead to delays or even denials of requests. One common mistake is failing to accurately fill in the case title at the top of the form. This title must match the one on the order or judgment being appealed. If the title is incorrect or missing, it can create confusion about the case and may cause the court to reject the motion.

Another frequent error involves the dates required on the form. Applicants often overlook the importance of the notarization date for the affidavit and the return date for the motion. The return date must be set appropriately based on how the motion papers were served. If the dates do not align with the service method—either personal delivery or mail—the motion may not be accepted. It is essential to double-check these dates to ensure compliance with court rules.

People also sometimes forget to include necessary documents when submitting the motion. Along with the motion papers, the original order or judgment being appealed, along with proof of service, must be attached. Failing to provide these documents can lead to delays, as the court may require them to process the motion. Ensuring all required paperwork is included is crucial for a smooth application process.

Lastly, applicants may neglect to serve all parties involved in the case. Proper service is critical and must include not just the opposing party but also their attorney and any relevant county attorneys. If service is incomplete, the motion may not be considered valid. It is vital to follow the service requirements closely to avoid complications.

What is the New York Poor Person form?

The New York Poor Person form is a legal document used to request permission to appeal a court decision without the financial burden of court fees. It allows individuals who cannot afford legal costs to seek justice in family court appeals.
Who is eligible to use the Poor Person form?

Eligibility is typically determined by your financial situation. If you can demonstrate that you do not have the means to pay court fees, you may qualify. Factors such as income, expenses, and dependents will be considered.
How do I fill out the Poor Person form?

Begin by entering the title of your case at the top left corner of the form. Follow the instructions carefully to fill in your personal information, the nature of the proceeding, and the details of your appeal. Ensure that all underlined spaces are completed accurately.
What should I include with my motion papers?

Along with the Poor Person form, you must attach a copy of the order or judgment you are appealing, any relevant decisions, and a copy of your notice of appeal. Additionally, proof of service of the motion papers on all relevant parties is required.
How do I serve the motion papers?

Motion papers should be served on all parties involved in the case. If a party has an attorney, serve them directly. If a party is represented by the Office of the Attorney General, send your papers there. You may deliver them in person or by mail, but the return date will differ based on your method of service.
What is the return date for the motion?

The return date is the day you expect the court to review your motion. If you serve the papers in person, this date should be at least eight days after service. If you use mail, it must be at least thirteen days after mailing.
Will there be an oral argument on the return date?

No, there will not be an oral argument on the return date. The motion will be submitted based on the written papers you provide.
What happens after I submit my motion?

After submitting your motion, the court will review the documents and make a decision regarding your request for Poor Person status and assignment of counsel. You will be notified of the court's decision, which may take some time.
What if my motion is denied?

If your motion is denied, you may still pursue your appeal, but you will be responsible for any associated costs. Consider consulting with a legal professional to explore your options moving forward.
Where do I send my completed Poor Person form?

Your completed form should be sent to the New York Supreme Court, Appellate Division, Third Judicial Department, at the address provided on the form. Make sure to keep a copy for your records and send copies to all parties involved in your case.

Misconceptions about the New York Poor Person form can lead to confusion for those seeking to navigate the legal system. Here are ten common misconceptions along with clarifications:

It is only for individuals with no income. Many people believe that the Poor Person form is only for those who are completely without income. However, it is designed for anyone who cannot afford the costs associated with legal proceedings, even if they have some income.
Filing the form guarantees legal representation. Some assume that submitting the Poor Person form automatically secures a lawyer. While it requests the assignment of counsel, approval is subject to the court's discretion based on the merits of the case.
Only certain cases qualify for the form. There is a misconception that the form is limited to specific types of cases. In reality, it can be used for various legal matters, including family court appeals, as long as the applicant demonstrates financial need.
The form must be filled out perfectly the first time. Many people worry that any mistakes will lead to rejection. While accuracy is important, courts often allow for corrections or additional documentation if needed.
Oral arguments are required during the motion return date. Some believe that they must present their case in person at the return date. However, the process is typically handled on paper, and personal appearances are neither required nor permitted.
All parties must agree to the motion. It is a common belief that all parties involved must consent to the Poor Person application. In fact, the motion can be filed regardless of the other parties' opinions, although they must be notified.
The form is only for residents of New York City. Many think the Poor Person form is limited to New York City residents. However, it is available to anyone in New York State who meets the financial criteria.
Supporting documents are optional. Some individuals believe they can submit the form without any additional documentation. In reality, attaching relevant documents, such as the order being appealed, is crucial for the court's consideration.
Once filed, the motion cannot be changed. There is a misconception that once the Poor Person form is submitted, it cannot be altered. However, applicants can provide additional information or clarification if necessary.
Anyone can fill out the form without guidance. While individuals can complete the form on their own, many may benefit from assistance to ensure it is filled out correctly and comprehensively. Seeking help from legal aid organizations can be valuable.

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Filling out and using the New York Poor Person form requires careful attention to detail. Here are key takeaways to ensure a smooth process:

Accurate Case Title: Write the case title exactly as it appears on the order or judgment you are appealing. This title should be placed on the left side of the form.
Service of Motion Papers: Ensure that all parties receive copies of the motion papers. If a party has an attorney, serve the attorney. If the party is represented by the Office of the Attorney General, serve that office.
Timing for Return Date: If you deliver the motion papers personally, set the return date for at least eight days later. If you mail them, set it for at least thirteen days later.
Submit Original Motion Papers: After serving the motion papers, send the original along with proof of service to the court. Include copies of relevant documents, such as the order being appealed and the notice of appeal.
No Oral Argument: Be aware that there will be no oral argument on the return date of the motion. The court will decide based solely on the submitted papers.

Location (Bank)

Filling out the New York Poor Person form is an important step in seeking permission to proceed as a poor person in a family court appeal. It requires careful attention to detail and accurate information. Follow the steps below to ensure that you complete the form correctly and submit it in a timely manner.

At the top of the form, locate the section titled "Notice of Motion." Write the title of your case on the left side, exactly as it appears on the order or judgment you are appealing.
Fill in the date when the attached affidavit was notarized in the designated space.
Next, indicate the return date of the motion. This should be a Monday after you have served the motion papers on all parties involved.
Ensure that you serve the motion papers on all parties. If a party has an attorney, serve the attorney. If a party is represented by the Office of the Attorney General, serve that office as well. Also, serve the County Attorney and any Attorney for the Child.
If you deliver the motion papers personally, set the return date for at least eight days after the service. If you mail the papers, the return date should be at least thirteen days after mailing.
After serving the motion papers, send the original documents along with proof of service to the court. Include a copy of the order or judgment you are appealing, the decision it is based on, and a copy of your notice of appeal.
Remember, there will not be any oral argument on the return date of the motion.
Complete the underlined spaces in the form. Return the original to the court, and send copies to each party involved, the County Attorney, and the Attorney for the Child. Keep a copy for your records.

Once you have filled out the form and submitted it, you will be awaiting a response from the court regarding your request. Make sure to keep track of any deadlines and maintain copies of all documents for your records. Good luck!

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