Electronic Testimony Application And Waiver Of Personal Appearance {4-24}

F.C.A. 247247 433, 531 - a, 580 - 316; D.R.L. 24775 - j Form 4 - 24/ 5 - 16/UIFSA - 10/UCCJEA - 7 3/2018 ELECTRONIC TESTIMONY APPLICATION AND WAIVER OF PERSONAL APPEARANCE FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF In the Matter of a Proceeding for Support or Paternity Under Article 4, 5 or 5 - B ( UIFSA ) of the Family Court Act or a Proceeding under Article 5 - A ( UCCJEA ) of the Domestic Relations law Petitioner, S.S.#: xxxx - xx - - against - DOCKET NO. Respondent. ELECTRONIC TESTIMONY APPLICATION AND WAIVER OF S.S.#: xxxx - xx - PHYSICAL PRESENCE NOTICE: If you are requesting permissio n to testify by telephone or by audio - visual or other electronic means, this form must be submitted IMMEDIATELY to the Court at [specify address and fax number or secure e - mail, if available, of Court]: APPL - ADDRESS: 1 (Work): ( ) - (Cell): ( ) - FACSIMILE (Fax) - : ( ) - E - MAIL: SKYPE ID: 1. On , I [check applicable box]: filed the above - captioned petition in the (Family)(Other [specify]: ) Court, County, State of (New York)(Other [specify]: ). The hearing is scheduled to take place on [specify date]: . recei ved a [check applicable box]: summons subpoena to appear in Family Court, c ounty, State of New York on [specify date]: . 2. I request that I be permitted to testify or to give my deposition by [check applicable box]: telephone audio - visual means other electronic means (specify): . 1 Specify if address, telephone or other identifying information has been ordered to be kept confidential pursuant to New York State Domestic Relations Law 24724776 - h, 254 or Family Court Act 247154 - b. If your health, safety or liberty or that of your child or children would be put at risk by disclosure of your address or other identifying information, you may app ly for an address confidentiality order by submitting General Form GF - 21 to this Court. his form is availabl e on - line at www.nycourts.gov American LegalNet, Inc. www.FormsWorkFlow.com Form 4 - 24/ 5 - 16/UIFSA - 10 /UCC 3. I am making this request for the following reason(s) [check one or more box(es)]: [ Non - New York State Resi dents only ]: I reside in [specify state or jurisdiction]: and am making this request for the following reason(s) [spec ify]: [ New York State residents only in child support or paternity cases ]: I reside in County, New York . This county is not the county where the Family Court is located and is not contiguous to (next to) that county. 2 It would be an undue hardship for me to testify or to be deposed at the Family Court where the case is scheduled to be heard for the following reason(s) [specify]: I am presently incarcerated at [specify facility]: I will be incarcerated on the date on which the hearing or deposition is schedul ed and I am not expected to be released until [specify approximate expected date of release]: . 4. I understand that prior to my application being granted, i t is my responsibility to arrange a location for my testimony or depos i tion with the Court. I request that I be permitted to testify or be deposed from the following location [check applicable box and include all information]: [Child support cases on ly]: The Support Enforcement Agency in my County [specify the name, address and telephone number, including area code]: The Court in my County [specify the name, address and telephone number, inc luding area code]: . . Other locat ion [specify name. address and telephone number, including area code]: I am requesting this location because [state reason]: 5. I understand that I must confirm final arrangements for testifying by electronic means with this Court by calling the telephone number that will be provided to me. I further understand that the Court will send me a written Order telling me whether this application has been granted or denied and what number I should call to confirm. Please transmit this order by [check box]: e - m ail facsimile as indicated on the first page of this form. 6. I understand that I have the right to discuss this ma tter with legal counsel. By this application, I am consenting to the hearing and determination of this matter by this Court without my physical presence. 2 For purposes of this application, the five counties (boroughs) of New York City are treated as one county. American LegalNet, Inc. www.FormsWorkFlow.com Form 4 - 24/ 5 - 16/UIFSA - 10 /UCC 7. I understand that I have the right to be present at any and all appearances, including any he aring scheduled by the Court. I understand that if I fail to appear on any of the sch eduled dates, either in person or by telephone, audio - visual means or other electronic means approved by this Court, this Court may hear the matter in my absence or may issue a WARRANT for my arrest. If I am the Petitioner, I understand that if I fail to appear, either in person or by telephone, audio - visual means or other electronic means approved by this Court, the Court may DISMISS my petition. 8. I understand tha t I must forward to the Court, prior to my scheduled appearance, proof of my identity and [child support cases only]: the completed financial documentation as requested in the attached summons. WHEREFORE, for the reasons stated above, I respectfully requ est that this application be granted. Dated :. Respondent Petitioner Witness American LegalNet, Inc. www.FormsWorkFlow.com