Affidavit In Support Of Application To Proceed As A Poor Person - New York Supreme Court
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7[Fill in the spaces next to the instructions. Attach copies of the indicated documents
and mark them as exhibits. Sign your name in the presence of a notary public]
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------------x
[1. Index No. & Year]
,
Index No.
[2. Fill in name(s)]
Plaintiff(s)
/
AFFIDAVIT IN SUPPORT
-against-
OF APPLICATION TO
PROCEED AS A POOR
,
PERSON
[3. Fill in name(s)]
Defendant(s)
-----------------------------------------------------------------------------x
STATE OF NEW YORK,
COUNTY OF NASSAU ss:
I, [4. Your name]
, being duly sworn,
deposes and says:
1) I reside at [5. Your Address]
, in
the State of New York and I have resided in the State of New York for the past
years. [6. Insert number of years you have resided in New York.]
2) I am about to commence a lawsuit for[7. Explain your type of case.]
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________________________________________ ______
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