Fill and Sign the New York Affidavit 497322004 Form

SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF       --------------------------------------------------------------------X       Plaintiff, Index No.:       -against- AFFIDAVIT OF PLAINTIFF       Defendant. --------------------------------------------------------------------X STATE OF       } ss: COUNTY OF       }       being duly sworn, says: 1. The Plaintiff’s address is       , and social security number is       . The Defendant’s address is       ,       and social security number is       . 2. The Plaintiff has resided in New York State for a continuous period in excess of two years immediately preceding the commencement of this action. OR The Defendant has resided in New York State for a continuous period in excess of two years immediately preceding the commencement of this action. OR The Plaintiff has resided in New York State for a continuous period in excess of one year immediately preceding the commencement of this action, and: a. the parties were married in New York State. b. the Plaintiff has lived as husband or wife in New York State with the Defendant. c. the cause of action occurred in New York State. OR The Defendant has resided in New York State for a continuous period in excess of one year immediately preceding the commencement of this action, and: a. the parties were married in New York State. b. the Defendant has lived as husband or wife in New York State with the Plaintiff. c. the cause of action occurred in New York State. OR The cause of action occurred in New York State and both parties were residents thereof at the time of the commencement of this action. 3. I married the Defendant on       , in the City, Town or Village of       , County of       , State or Country of       . The marriage was not performed by a clergyman, minister or by a leader of the Society for Ethical Culture. (Form UD-6 - Rev. 5/99) (If the word “not” is deleted, check one of the following below:) To the best of my knowledge I have taken all steps solely within my power to remove any barrier to the Defendant’s remarriage. OR I will take prior to the entry of final judgment all steps solely within my power to the best of my knowledge to remove any barrier to the Defendant’s remarriage. OR The Defendant has waived in writing the requirements of DRL §253 (Barriers to Remarriage ). 4. There is (are)       child(ren) of the marriage: Name & Social Security Number Date of Birth                                                             The present address of each child under the age of 18 and all other places where each child lived within the last five (5) years is as follows: Child Present Address                                                 Child Other Address Within Last 5 years                                                 The name(s) and present address(es) of the person(s) with whom each child under the age of 18 has lived within the last five (5) years is:                                                 I have participated in other litigation concerning the custody of the child(ren) in this or another state. Yes No I have information of a custody proceeding concerning the child(ren) pending in a court of this or another state. Yes No I know of a person who is not a party to this proceeding who has physical custody of the child(ren) or claims to have custody or visitation rights with respect to the child(ren). Yes No The parties are covered by the following group health plans: Plaintiff Defendant Group Health Plan:       Group Health Plan:       (Form UD-6 - Rev. 5/99) Address:       Address:       Identification Number:       Identification Number:       Plan Administrator:       Plan Administrator:       Type of Coverage:       Type of Coverage:       OR Not Applicable. 5. In addition to the dissolution of the marriage, I am seeking the following relief:                   AND equitable distribution of marital property; OR marital property to be distributed pursuant to the annexed separation agreement / stipulation; OR I waive equitable distribution of marital property; and any other relief the court deems fitting and proper. 6. The grounds for dissolution of the marriage are as follows: Cruel and Inhuman Treatment (DRL §170(1)) : At the following times, none of which are earlier than (5) years prior to commencement of this action, the Defendant engaged in conduct that so endangered the mental and physical well-being of the Plaintiff, so as to render it unsafe and improper for the parties to cohabit (live together) as husband and wife. (State the facts that demonstrate cruel and inhuman conduct giving dates, places and specific acts. Conduct may include physical, verbal, sexual or emotional behavior.)                   (Attach an additional sheet, if necessary). Abandonment (DRL 170(2): That commencing on or about       , and continuing for a period of more than one (1) year immediately prior to commencement of this action, the Defendant left the marital residence of the parties located at       , and did not return. Such absence was without cause or justification, and was without Plaintiff’s consent. (Form UD-6 - Rev. 5/99) That commencing on or about       , and continuing for a period of more than one (1) year immediately prior to commencement of this action, the Defendant refused to have sexual relations with the Plaintiff despite Plaintiff’s repeated requests to resume such relations. Defendant does not suffer from any disability which would prevent her/him from engaging in such sexual relations with Plaintiff. The refusal to engage in sexual relations was without good cause or justification and occurred at the marital residence located at       . That commencing on or about the       , and continuing for a period of more than one (1) year immediately prior to commencement of this action, the Defendant willfully and without cause or justification abandoned the Plaintiff, who had been a faithful and dutiful husband/wife , by depriving Plaintiff of access to the marital residence located at       . This deprivation of access was without the consent of the Plaintiff and continued for a period of greater than one year. Confinement to Prison (DRL §170(3)): (a) That after the marriage of Plaintiff and Defendant, Defendant was confined in prison for a period of three or more consecutive years, to wit: that Defendant was confined in       prison on       , and has remained confined to this date; and (b) not more that five (5) years elapsed between the end of the third year of imprisonment and the date of commencement of this action. Adultery (DRL §170(4)): (a) That on       , at the premises located at       , the Defendant engaged in sexual intercourse with       , without the procurement nor the connivance of the Plaintiff, and the Plaintiff ceased to cohabit (live) with the Defendant upon the discovery of the adultery; and (b) not more than five (5) years elapsed between the date of said adultery and the date of commencement of this action. (Attach a corroborating affidavit of a third party witness or other additional proof). Living Separate and Apart Pursuant to a Separation Decree or Judgment of Separation (DRL §170(5)): (a) That the       Court,       County,       (Country or State) rendered a decree or judgment of separation on       under Index Number:       ; and (b) that the parties have lived separate and apart for a period of one year or longer after the granting of such decree; and (c) that the Plaintiff has substantially complied with all the terms and conditions of such decree or judgment. Living Separate and Apart Pursuant to a Separation Agreement (DRL §170(6)): (a) That the Plaintiff and Defendant entered into a written agreement of separation, which they subscribed and acknowledged on       , in the form required to entitle a deed to be recorded; and (b) that the agreement / memorandum of said agreement was filed on       in the Office of the Clerk of the County of       , wherein Plaintiff / Defendant resided; and (c) that the parties have lived separate and apart for a period of one year or longer after the execution of said agreement; and (d) that the Plaintiff has substantially complied with all terms and conditions of such agreement. (Form UD-6 - Rev. 5/99) 7. Defendant is not in the active military service of this state, or any other state or this nation. I know this because: he / she admitted it to me / the process server on       I have submitted with these papers an investigator’s affidavit / Defendant’s affidavit which states that Defendant is not in the active military service of this state, or any other state or this nation. 8. I am not receiving Public Assistance. To my knowledge the Defendant is not receiving Public Assistance. 9. No other matrimonial action is pending in this court or in any other court, and the marriage has not been terminated by any decree of any court of competent jurisdiction. 10 . Annexed to the “Affidavit of Service” of Summons and Complaint / Summons With Notice is a photograph. It is a fair and accurate representation of the Defendant. 11A. I am not the custodial parent of the child (ren) of the marriage. OR 11B. I am the custodial parent of the unemancipated child (ren) entitled to receive child support pursuant to DRL §236(B)(7)(b), AND (1) I request child support services through the Support Collection Unit which would authorize collection of the support obligation by the immediate issuance of an income execution for support enforcement. OR (2) I am in receipt of such services through the Support Collection Unit. OR (3) I have applied for such services through the Support Collection Unit. OR (4) I am aware of but decline such services through the Support Collection Unit at this time. I am aware that an income deduction order may be issued pursuant to CPLR §5242(c) without other child support enforcement services and that payment of an administrative fee may be required. If (1) or (4) is selected, the following information must be included on a separate information sheet (Form UD-8a): Name, date of birth, address and social security number of each party; date and place of marriage; names and dates of birth of the children; and name and address of employer of the payor (non- custodial parent). Plaintiff’s OR Defendant’s prior surname is:       . WHEREFORE , I       (print name), respectfully request that judgment be entered for the relief sought and for such other relief as the court deems fitting and proper. Subscribed and Sworn to before me on __________________________ (Form UD-6 - Rev. 5/99) Plaintiff’s Signature       Notary Public (Form UD-6 - Rev. 5/99)