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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 legal fees. This form is essential for those seeking to have legal representation in family court appeals while ensuring that financial constraints do not hinder their access to justice. To begin the process, fill out the form by clicking the button below.

Article Guide

For individuals facing financial hardship in New York, the Poor Person form serves as a vital tool in navigating the legal system. This form allows those who cannot afford the costs associated with an appeal to request permission to proceed as a "poor person," which can include the assignment of legal counsel. At the heart of the process is a Notice of Motion, where the title of the case must be accurately listed, mirroring how it appears on the original order or judgment being appealed. Dates play a crucial role; the form requires the date the supporting affidavit was notarized and the return date for the motion, which is typically set for a Monday following the service of motion papers. Proper service of these papers is essential and must be conducted on all involved parties, including attorneys and the County Attorney, ensuring everyone is adequately informed. Once the motion papers are served, the original documents, along with proof of service, should be sent to the appropriate court office. It's important to note that there will not be any oral arguments on the return date, making the completion and submission of this form a critical step for those seeking justice without the burden of financial strain.

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

➤ PDF File

Fact Name	Description
Governing Law	The New York Poor Person form is governed by Section 800.2(a) of the Rules of the Court.
Purpose	This form allows individuals to request permission to appeal as a poor person and seek assignment of counsel.
Filing Location	The form must be submitted to the Supreme Court, Appellate Division, Third Judicial Department in Albany, NY.
Caption Requirement	The title of the case must be placed on the left side, matching the order or judgment being appealed.
Notarization Date	The affidavit in support of the motion must include the date it was notarized.
Service of Motion Papers	Motion papers must be served on all parties, including their attorneys and the County Attorney.
Return Date	The motion is returnable on a Monday, either 8 days after personal delivery or 13 days after mailing.
No Oral Argument	There will be no oral argument on the return date of the motion.
Required Attachments	Attach copies of the order or judgment being appealed, the decision, and the notice of appeal.
Record Keeping	Keep a copy of the motion papers for your records after filing and serving them.

Completing the New York Poor Person form is an important step in seeking permission to appeal as a poor person and obtaining legal counsel. Following these instructions carefully will help ensure that your application is submitted correctly and promptly.

At the top of the form, locate the section labeled "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. This is known as the caption.
Below the caption, find the sentence that begins with "Please take notice..". Fill in the first date with the date the attached affidavit was notarized. The second date should be the return date of the motion, which must be a Monday after you have served the motion papers on all parties.
Serve the motion papers on all parties involved. If someone is represented by an attorney, deliver the papers to the attorney. If a party is represented by the Office of the Attorney General, serve them there as well. Don't forget to also serve the County Attorney and any Attorney for the Child.
If you deliver the motion papers in person, set the return date for a Monday at least eight (8) days after the delivery. If you mail the papers, the return date should be a Monday at least thirteen (13) days after mailing.
After serving the motion papers, promptly send the original motion papers along with proof of service to the specified office. If this motion relates to an appeal, 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.
Be aware that there will be no oral argument on the return date of the motion.
Fill in all underlined spaces in the form. Once completed, return the original to the court, send one copy to each of your adversaries, one copy to the County Attorney, one to the Attorney for the Child, and keep a copy for your records.

Once you have completed these steps, your application will be ready for submission. Ensure all information is accurate and that you have met all deadlines for service and filing. This will help facilitate a smoother process as you move forward with your appeal.

What is the New York Poor Person form?

The New York Poor Person form is a legal document that allows individuals to request permission to appeal a court decision without the financial burden of court fees. This form is particularly important for those who cannot afford the costs associated with legal proceedings. By completing this form, you can also seek the assignment of legal counsel to assist with your appeal.

Who can use the Poor Person form?

Any individual who is facing financial hardship and wishes to appeal a family court decision can use the Poor Person form. If you cannot afford the costs associated with your appeal, this form provides a way to request a waiver of those fees and the assignment of a lawyer.

How do I fill out the Poor Person form?

Begin by filling in the title of your case as it appears on the order you are appealing. Next, complete the sections regarding the dates and details of your motion. It’s essential to include your notarized affidavit and any supporting documents, such as the order being appealed. Make sure to serve copies of the motion papers to all relevant parties, including any attorneys involved.

What documents do I need to submit with the form?

You must attach several key documents when submitting the Poor Person form. These include a copy of the order or judgment you are appealing, any relevant decisions, and a notice of appeal. Additionally, provide proof that you have served the motion papers to the other parties involved in the case.

What happens after I submit the Poor Person form?

After submitting the form, the court will review your request. There will be no oral argument on the return date of the motion. If approved, you will be granted permission to proceed as a poor person, and you may be assigned legal counsel to assist with your appeal.

Are there deadlines I need to be aware of?

Yes, timing is crucial. You must ensure that your motion is returnable on a Monday at least eight days after personal service or thirteen days after mailing the motion papers. Additionally, the affidavit must be notarized before you submit your motion, and all documents should be served promptly to avoid delays in your appeal process.

Can I represent myself if I submit the Poor Person form?

While you can represent yourself, the Poor Person form also allows you to request legal counsel. If granted, an attorney will be assigned to assist you. This can be beneficial, as navigating the legal system can be complex, and having professional guidance may improve your chances of a successful appeal.

Incorrect Captioning: One common mistake is failing to accurately write the title of the case in the caption. This title should match exactly how it appears on the order or judgment being appealed. If this detail is overlooked, it can lead to confusion and potential delays in processing the motion.
Missing Dates: Another frequent error involves not filling in the required dates correctly. The affidavit's notarization date and the motion's return date must be precise. For instance, the return date should be set appropriately based on how the motion papers were served, whether by mail or personal delivery. Inaccurate dates can result in procedural issues.
Improper Service of Motion Papers: People often neglect to serve all necessary parties as outlined in the instructions. It's crucial to serve not just the opposing party, but also their attorney and other relevant parties, such as the County Attorney and Attorney for the Child. Failure to do so can jeopardize the entire motion.
Omitting Required Documents: Lastly, individuals sometimes forget to attach essential documents to their motion. This includes the order or judgment being appealed, the decision upon which it is based, and the notice of appeal. Without these documents, the court may not have sufficient information to evaluate the motion.

The New York Poor Person form is an essential document for individuals seeking to appeal a family court decision without the financial means to cover legal costs. Along with this form, several other documents are often required to support the motion for poor person status and assignment of counsel. Below is a list of these documents, each described briefly to clarify their purpose and importance.

Notice of Appeal: This document formally indicates a party's intention to appeal a court decision. It must be filed with the court and served to all involved parties to ensure everyone is informed of the appeal.
Affidavit of Service: This affidavit serves as proof that the motion papers have been properly delivered to all necessary parties, including any attorneys involved. It is crucial for demonstrating compliance with court rules regarding service.
Order or Judgment Being Appealed: A copy of the specific order or judgment that is being challenged must be attached to the motion. This document provides the basis for the appeal and outlines the decision the appellant seeks to contest.
Decision or Opinion: If available, a copy of the court's decision or opinion that led to the order or judgment being appealed should be included. This helps clarify the context and reasoning behind the original ruling.
Financial Affidavit: This document outlines the appellant's financial situation, detailing income, expenses, and assets. It supports the claim of being unable to afford legal fees and is often a key component of the poor person application.
Proof of Income: Recent pay stubs or other documentation that verifies the appellant's income may be required. This information helps the court assess the individual's financial status more accurately.
Additional Supporting Documents: Any other relevant documents that bolster the appellant's case or provide context for the appeal may be included. This could encompass prior court records or evidence pertinent to the appeal.

Each of these documents plays a vital role in the appeal process, ensuring that the court has all necessary information to consider the motion for poor person status and assignment of counsel. Properly preparing and submitting these documents can significantly impact the outcome of the appeal.

The New York Poor Person form is similar to several other legal documents that help individuals navigate the court system, especially when financial constraints are present. Here’s a breakdown of those documents:

Affidavit of Support: This document is often used in various legal proceedings to provide a sworn statement of an individual's financial situation. Like the Poor Person form, it aims to establish eligibility for certain benefits or assistance based on financial need.
Application for Waiver of Fees: This form requests the court to waive filing fees due to financial hardship. Similar to the Poor Person form, it requires detailed financial information to demonstrate the inability to pay.
Motion for Assignment of Counsel: This document requests the court to appoint an attorney for individuals who cannot afford one. It shares the goal of ensuring fair representation, much like the Poor Person form.
Notice of Appeal: This document formally initiates an appeal. While it doesn't address financial status, it is often accompanied by the Poor Person form when someone is appealing a decision but lacks the funds to proceed.
Financial Disclosure Statement: This statement provides a detailed account of an individual's financial situation. It is similar in purpose to the Poor Person form, as it helps the court assess the ability to pay for legal services.
Request for Pro Bono Representation: This document asks for free legal services from attorneys. Like the Poor Person form, it is aimed at individuals who cannot afford legal representation.
Petition for Relief from Judgment: This document seeks to overturn a previous court decision. When financial constraints are involved, it may be accompanied by the Poor Person form to indicate the petitioner's financial situation.

When filling out the New York Poor Person form, there are several important considerations to keep in mind. Here’s a list of things you should and shouldn’t do:

Do ensure that the title of your case is exactly as it appears on the order or judgment you are appealing from.
Don’t forget to notarize the affidavit in support of your motion before submitting it.
Do serve all required parties, including attorneys, the County Attorney, and the Attorney for the Child, with the motion papers.
Don’t make your motion returnable too soon. Allow at least eight days for personal delivery or thirteen days if mailed.
Do attach a copy of the order or judgment being appealed, along with any relevant decisions and your notice of appeal.
Don’t expect oral arguments on the return date; the motion will be submitted on papers only.
Do keep a copy of everything for your own records after serving the necessary parties.

By following these guidelines, you can ensure a smoother process as you navigate the legal system.

Misconceptions about the New York Poor Person form can lead to confusion and hinder the process of seeking assistance. Here are six common misunderstandings:

It is only for individuals with no income. Many believe that the form is exclusively for those who are completely unemployed or without any income. In reality, it is designed for anyone who cannot afford the costs associated with legal proceedings, even if they have a low income.
Filing the form guarantees legal representation. Some assume that submitting the Poor Person form automatically results in being assigned a lawyer. While it does allow for the possibility of having counsel assigned, approval is based on the merits of the case and the court's discretion.
The form is only applicable to certain types of cases. There is a misconception that the Poor Person form can only be used in specific legal matters. However, it can be applied in various cases, including family court appeals, as long as the individual meets the financial criteria.
It is unnecessary to serve other parties with the motion papers. Some people think they can file the form without notifying other involved parties. In fact, serving the motion papers to all relevant parties is a crucial step in the process.
Oral arguments are always part of the process. Many believe that oral arguments will be heard after filing the Poor Person form. However, the instructions clearly state that there will not be oral arguments on the return date of the motion.
Once filed, the process is quick and straightforward. There is a common belief that once the form is submitted, the process will move quickly. In reality, it can take time for the court to review the motion and make a decision, depending on the complexity of the case and the court's schedule.

Location (Bank)

When filling out and using the New York Poor Person form, keep the following key takeaways in mind:

Correctly Title Your Case: Ensure that the title of your case appears exactly as it does on the order or judgment you are appealing. This is crucial for proper identification.
Service of Motion Papers: You must serve the motion papers to all parties involved. If someone has an attorney, send the papers to the attorney. Follow the specific timelines for service, whether by personal delivery or mail.
Submit Original Motion Papers Promptly: After serving the motion papers, forward the original documents and proof of service to the court as soon as possible. Include copies of the order or judgment you are appealing.
No Oral Argument: Be aware that there will not be any oral argument on the return date of the motion. The decision will be made based solely on the submitted papers.