Fill and Sign the Drl 75 J Form

1 Specify if address, telephone or other identifying information has been ordered to be kept confidential pursuant toNew York State Domestic Relations Law §§76-h(5), 254 or Family Court Act §154-b. If your health or safety orthat of your child or children would be put at risk by disclosure of your address or other identifying information,you may apply for an address confidentiality order by submitting General Form GF-21. This form is available on-line at www.nycourts.gov . See note 1. 2DRL §75-j Form UCCJEA-7(Electronic Testimony Application and Waiver of Physical Presence– UCCJEA) 9/2008 FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF ............................................................................. In the Matter of a Proceeding for “ Custody “ Visitation or“ Enforcement “ Modification “ Registration of an Order of “ Custody “ VisitationUnder the Uniform Child Custody Jurisdiction and Enforcement Act [Domestic Relations Law Art.5-A] Petitioner, -against-Docket No.ELECTRONIC TESTIMONY APPLICATION,WAIVER OF PHYSICAL PRESENCE– UCCJEA Respondent............................................................................NOTICE: If you are requesting permission to testify by telephone or by audio-visual or otherelectronic means, this form must be submitted IMMEDIATELY to the Court at [specify address andfax number of Court]:_____________________________________________________________________________________APPLICANT’S NAME: _________________ APPLICANT’S TELEPHONE: (Home): ( ) ___ - ADDRESS: __________________________ (Work): ( ) ___ - ________ 1 __________________________ FACSIMILE (Fax): ( ) ___ - ________ __________________________ E-MAIL: _________________________ 1. a. 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 isscheduled to take place on [specify date]: . ” received [check applicable box]: ” a summons ” a subpoena ” an Order to Show Cause toappear in Family Court, County, State of New York on [specify date]: b. This proceeding involves the following child(ren): Name(s) of Child(ren)Date(s) of BirthAddress2 Form UCCJEA-7 Page 2 See footnote #1. 32. 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]: 3. I reside in [specify state or jurisdiction]: ___________________________________________________ 3 and am making this request for the following reason(s) [specify]:________________________________________________________________________________ . 4. I understand that prior to my application being granted, it is my responsibility to arrange a location for mytestimony or deposition by telephone, audio-visual or other electronic means. I request that I bepermitted to testify or be deposed at the following location [check applicable box]: ” The Court in the jurisdiction of my residence [specify the name, address and telephone number,including area code, of the Court]: ” My attorney’s office [specify the name, address and telephone number, including area code]: ” Other location [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 Courtby calling the Court at the number that will be provided to me. I also understand that the Court will sendme a written Order telling me whether this application has been granted or denied and what number I shouldcall to confirm. Please transmit this order by [check box]: G e-mail G facsimile as indicated on thefirst page of this form.6. I understand that I have the right to discuss this matter with legal counsel. By this application, I am consenting to the hearing by this Court without my physical presence. 7. I understand that I have the right to be present at any and all appearances, including any hearingscheduled by the Court. If I am the Respondent, I understand that if I fail to appear on any of the scheduleddates, 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 thePetitioner, I understand that if I fail to appear, either in person or by telephone, audio-visual means or otherelectronic means approved by this Court, the Court may DISMISS my petition. WHEREFORE, I respectfully request that this application be granted.Dated:________________________._______________________________________________” Respondent ” Petitioner ” Witness