Form CIV-GP-15-i "Affidavit in Support of an Application to Proceed as a Poor Person and to Waive Court Fees" - New York

What Is Form CIV-GP-15-i?

This is a legal form that was released by the New York State Unified Court System - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2004;
  • The latest edition provided by the New York State Unified Court System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CIV-GP-15-i by clicking the link below or browse more documents and templates provided by the New York State Unified Court System.

ADVERTISEMENT
ADVERTISEMENT

Download Form CIV-GP-15-i "Affidavit in Support of an Application to Proceed as a Poor Person and to Waive Court Fees" - New York

Download PDF

Fill PDF online

Rate (4.7 / 5) 48 votes
Civil Court of the City of New York
County of
Index Number
Part
In the Matter of the Application of
AFFIDAVIT IN SUPPORT OF
AN APPLICATION TO
PROCEED AS A POOR PERSON
AND TO WAIVE COURT FEES
to prosecute as a poor person against
State of New York, County of
ss:
, being duly sworn, deposes and says:
PRINT YOUR NAME
1. I am the party named as
in the above titled action.
2. 1 reside at
3. 1 seek to proceed in the above titled action.
4. 1 have a good and meritorious cause of action in that
5. 1 request that an Order be granted:
waiving any and all statutory fees for the defense or prosecution of the action,
waiving the fee for the filing of a Notice of Appeal
other (Specify)
6. 1 make this application based on CPLR §1101. I do not have, nor am I able to obtain, the funds needed to pay the
court fees. I will be unable to proceed unless the Order is granted.
7. 1 am/am not a recipient of Public Assistance from the Department of Social Services of the City of New York.
8. 1 have no income other than the sum of $
per
from
9. 1 own no property of any kind except necessary personal wearing apparel and
[Indicate other property and the value of such property]
10. No other person is beneficially interested in the recovery sought.
11.
a) I have not made a previous application for this or similar relief.
b) I have made previous application(s) for this or similar relief, but I am making this further application
because
.
Sign your name
Print your address
Sworn to before me this
day of
20
Signature of Court Employee and Title
Telephone Number
CIV-GP-15-i(Revised 5/04)
FREE CIVIL COURT FORM
No fee may be charged to fill in this form.
Form can be found at: http://www.nycourts.gov/courts/nyc/civil/forms.shtml.
Civil Court of the City of New York
County of
Index Number
Part
In the Matter of the Application of
AFFIDAVIT IN SUPPORT OF
AN APPLICATION TO
PROCEED AS A POOR PERSON
AND TO WAIVE COURT FEES
to prosecute as a poor person against
State of New York, County of
ss:
, being duly sworn, deposes and says:
PRINT YOUR NAME
1. I am the party named as
in the above titled action.
2. 1 reside at
3. 1 seek to proceed in the above titled action.
4. 1 have a good and meritorious cause of action in that
5. 1 request that an Order be granted:
waiving any and all statutory fees for the defense or prosecution of the action,
waiving the fee for the filing of a Notice of Appeal
other (Specify)
6. 1 make this application based on CPLR §1101. I do not have, nor am I able to obtain, the funds needed to pay the
court fees. I will be unable to proceed unless the Order is granted.
7. 1 am/am not a recipient of Public Assistance from the Department of Social Services of the City of New York.
8. 1 have no income other than the sum of $
per
from
9. 1 own no property of any kind except necessary personal wearing apparel and
[Indicate other property and the value of such property]
10. No other person is beneficially interested in the recovery sought.
11.
a) I have not made a previous application for this or similar relief.
b) I have made previous application(s) for this or similar relief, but I am making this further application
because
.
Sign your name
Print your address
Sworn to before me this
day of
20
Signature of Court Employee and Title
Telephone Number
CIV-GP-15-i(Revised 5/04)
FREE CIVIL COURT FORM
No fee may be charged to fill in this form.
Form can be found at: http://www.nycourts.gov/courts/nyc/civil/forms.shtml.