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The New York Poor Person form is a legal document that allows individuals with limited financial resources to request permission to appeal a court decision without the burden of court fees. This form is essential for those seeking legal representation in family court appeals when they cannot afford to pay for counsel. Understanding how to complete this form correctly is crucial for ensuring access to justice for all.

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For individuals facing financial hardship, the New York Poor Person form serves as a crucial tool in navigating the complexities of the legal system, particularly in family court appeals. This form allows those who cannot afford the costs associated with legal proceedings to request permission to proceed without the financial burden of court fees. At the top of the form, you’ll find a Notice of Motion where the title of your case is entered, ensuring that it aligns with the order or judgment you are appealing. The form requires you to fill in key dates, including when your affidavit was notarized and when the motion will be heard, typically set for a Monday following the service of your motion papers. It’s essential to serve these papers on all relevant parties, including any attorneys involved, the County Attorney, and the Attorney for the Child. This process must be completed carefully to ensure compliance with the court’s requirements. Once served, you’ll need to send the original motion papers along with proof of service to the court, attaching any necessary documents related to your appeal. Importantly, the court will not hold oral arguments on the return date of the motion, streamlining the process for those in need. Understanding these steps can empower you to advocate for your rights and access the justice system, even when finances are tight.

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

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Fact Name	Details
Purpose of the Form	This form allows individuals to request permission to proceed as a poor person and seek assignment of counsel in family court appeals.
Governing Law	The form is governed by Section 800.2(a) of the Rules of the New York Supreme Court, Appellate Division.
Service Requirements	Motion papers must be served on all parties, including attorneys and the County Attorney, with specific timelines for personal delivery or mailing.
No Oral Argument	There will be no oral argument on the return date of the motion, as stated in the instructions.

Completing the New York Poor Person form is an important step in seeking permission to proceed as a poor person in a family court appeal. Following these steps will help ensure that you fill out the form correctly and submit it in a timely manner.

At the top of the form, locate the 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 from.
Below the title, find the sentence starting with "Please take notice..". Fill in the date when the attached affidavit was notarized. Then, enter the return date for the motion, which should be a Monday after you have served the motion papers.
Serve the motion papers on all parties involved. If a party has an attorney, serve them instead. Also, serve the County Attorney and any Attorney for the Child. If you deliver the papers in person, the return date should be at least eight days later. If you mail the papers, the return date should be at least thirteen days later.
After serving the motion papers, forward the original documents along with proof of service to the appropriate office. Include a copy of the order or judgment you are appealing, any decisions related to it, and the notice of appeal.
Remember that there will be no oral argument on the return date of the motion.
Complete all underlined spaces in the form. Return the original to the court, send one copy to each adversary, one to the County Attorney, one to the Attorney for the Child, and keep one for your records.

What is the New York Poor Person form?

The New York Poor Person form is a legal document that allows individuals who cannot afford to pay court fees to request permission to proceed with their appeal as a "poor person." This form also includes a request for the assignment of counsel, which means that the court may appoint an attorney to represent them in their appeal. It is primarily used in family court appeals within New York State.
Who is eligible to use the Poor Person form?

Any individual who finds themselves unable to pay the necessary court fees and costs associated with an appeal may be eligible to use this form. Eligibility is typically determined based on the applicant's financial situation, including income, expenses, and overall ability to pay. If you believe that your financial circumstances qualify you as a poor person, you should consider filling out this form.
How do I fill out the Poor Person form?

Filling out the Poor Person form involves several key steps:
- Begin by placing the title of your case at the top left of the form, exactly as it appears in the original order or judgment.
- Fill in the dates as required, including the date your affidavit was notarized and the return date for your motion.
- Provide all necessary information in the affidavit, detailing your financial situation and the nature of your appeal.
- Attach copies of relevant documents, such as the order or judgment being appealed, and proof of service to all parties involved.
Make sure to review the completed form for accuracy before submission.
What happens after I submit the Poor Person form?

Once you submit the Poor Person form, the court will review your application. It is important to note that there will not be an oral argument on the return date of your motion. The court will make a decision based on the documents you have provided. If your request is granted, you will be allowed to proceed without paying the usual fees, and you may also be assigned an attorney to assist with your appeal.
What if my application is denied?

If your application for poor person status is denied, you will be required to pay the court fees to proceed with your appeal. You may have the option to appeal the decision, but it is advisable to seek legal assistance if you are considering this route. Understanding the reasons for the denial can help you address any issues in a subsequent application.
Are there any deadlines I should be aware of?

Yes, there are specific deadlines associated with filing the Poor Person form. The return date for your motion must be set based on how you serve the motion papers. If served by personal delivery, it should be at least eight days after service. If served by mail, it should be at least thirteen days after mailing. Timeliness is crucial, so ensure you adhere to these deadlines to avoid complications in your appeal process.

Filling out the New York Poor Person form can be challenging, and many people make mistakes that can delay their case. One common error is failing to correctly write the title of the case. The title should match exactly how it appears on the original order or judgment. If it is written incorrectly, it can cause confusion and may lead to a rejection of the motion.

Another mistake often seen is not providing the correct dates. The form requires two specific dates: the date the affidavit was notarized and the return date of the motion. Missing or incorrect dates can complicate the process and may result in the motion being dismissed.

People sometimes overlook the requirement to serve all necessary parties. It is essential to serve the motion papers to everyone involved, including attorneys and the County Attorney. If someone is represented by the Office of the Attorney General, they also need to receive a copy. Failing to do this can lead to significant delays.

Additionally, some individuals forget to include proof of service with their motion papers. This proof is crucial as it shows that all parties were properly notified. Without it, the court may not accept the motion, causing further complications.

Another common issue is not attaching the required documents. The form asks for copies of the order or judgment being appealed, as well as any relevant decisions and the notice of appeal. If these documents are missing, it can result in the motion being incomplete.

Finally, many people fail to keep a copy of the completed form for their records. This can lead to confusion later on, especially if there are questions about what was submitted. Keeping a personal copy ensures that individuals have the necessary information at hand for future reference.

When applying to proceed as a poor person in New York, several other forms and documents may be necessary to support your application. These documents help provide a clearer picture of your financial situation and the nature of your appeal. Below is a list of commonly used forms that accompany the New York Poor Person form.

Notice of Appeal: This document informs the court and all parties involved that you intend to appeal a decision. It must be filed within a specific timeframe after the judgment or order you wish to contest.
Affidavit of Service: This affidavit serves as proof that you have properly served the motion papers to all relevant parties. It includes details about how and when the documents were delivered.
Order or Judgment Being Appealed: A copy of the actual order or judgment you are appealing must be included. This document outlines the court's decision that you are contesting.
Decision of the Lower Court: If available, this document provides the rationale behind the order or judgment being appealed. It is useful for the court to understand the context of your appeal.
Financial Disclosure Statement: This form outlines your financial situation, including income, expenses, and assets. It helps the court assess your eligibility for poor person status.
Certificate of Good Faith: This document asserts that you believe your appeal has merit and is not being filed for frivolous reasons. It reflects your intention to pursue the appeal seriously.

Each of these documents plays a critical role in the appeals process. They ensure that the court has all the necessary information to make informed decisions regarding your case. Properly preparing and submitting these forms can help streamline your appeal and improve your chances of receiving the assistance you need.

The New York Poor Person form is a crucial document for individuals seeking to appeal a court decision without the financial means to do so. Several other documents serve similar purposes in different legal contexts. Below is a list of these documents, along with explanations of their similarities to the New York Poor Person form.

Application to Proceed In Forma Pauperis: This document is used in federal courts to request permission to proceed without the payment of court fees. Like the Poor Person form, it assesses the applicant's financial situation to determine eligibility for fee waivers.
Affidavit of Indigency: Often required in various jurisdictions, this affidavit provides a sworn statement of an individual’s financial status. It parallels the Poor Person form by aiming to demonstrate the inability to afford legal expenses.
Motion for Appointment of Counsel: This motion requests that the court appoint legal representation for individuals who cannot afford an attorney. It is similar to the Poor Person form in that it seeks to ensure fair access to legal representation.
Fee Waiver Request Form: Many courts offer a fee waiver request form that allows individuals to apply for a waiver of filing fees. This document shares the same goal as the Poor Person form, which is to facilitate access to the legal system for those with limited financial resources.
Application for Public Defender Services: In criminal cases, defendants can apply for public defender services if they cannot afford a private attorney. This application functions similarly to the Poor Person form by evaluating the financial need for legal assistance.
Financial Disclosure Statement: This document is often required in family law cases to disclose an individual's financial situation. It relates to the Poor Person form as both aim to provide the court with a clear picture of the applicant's financial status.
Request for Pro Bono Representation: Individuals may submit a request for pro bono legal services, which are provided free of charge. This request mirrors the intent of the Poor Person form by seeking assistance for those who cannot afford legal fees.
Application for Legal Aid: This application is used to seek legal assistance from nonprofit organizations that provide free legal services. Like the Poor Person form, it is designed to help individuals gain access to legal support based on their financial circumstances.

When filling out the New York Poor Person form, it is essential to approach the process with care and attention to detail. Below are some important dos and don'ts to keep in mind.

Do ensure that the title of your case is written correctly, as it appears on the original order or judgment.
Do fill in the dates accurately, including the date the affidavit was notarized and the return date of the motion.
Do serve the motion papers on all parties involved, including their attorneys if they are represented.
Do forward the original motion papers along with proof of service to the appropriate office promptly.
Do attach all necessary documents, including copies of the order or judgment being appealed and the notice of appeal.
Don't forget that there will be no oral argument on the return date of the motion.
Don't assume that personal delivery and mailing have the same timeline for return dates; be mindful of the required days for each method.

Here are some common misconceptions about the New York Poor Person form:

It's only for people without any income. Many believe that only those with zero income can apply. In reality, the form is for anyone who cannot afford the costs associated with an appeal, even if they have a low income.
Filling out the form guarantees approval. Some think that submitting the form will automatically result in being granted poor person status. However, the court reviews each application based on its merits and financial circumstances.
Oral arguments are part of the process. A common misunderstanding is that there will be a hearing where you can present your case. The process is typically handled on paper, without oral arguments.
You can submit the form at any time. Some individuals believe they can file the form whenever they want. It's important to submit it in a timely manner, as there are deadlines related to the appeal process.

Location (Bank)

Filling out the New York Poor Person form can be a crucial step for individuals seeking legal assistance in family court appeals. Here are some key takeaways to keep in mind:

Accurate Information is Essential: Ensure that the title of your case matches exactly how it appears on the original order or judgment. This helps avoid confusion and ensures that your motion is processed correctly.
Service of Motion Papers: Properly serve your motion papers to all relevant parties, including attorneys and the County Attorney. This step is vital; failure to do so can delay your appeal.
Submission Requirements: After serving the motion papers, submit the original documents along with proof of service to the court. Don’t forget to include copies of any relevant orders or judgments.
No Oral Arguments: Be aware that there will be no oral arguments on the return date of your motion. The decision will be made based solely on the submitted papers.