Fillable MATRIMONIAL Request for Judicial Intervention Addendum (NYS Unified Court System Division of Technology)

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MATRIMONIAL Request for Judicial Intervention Addendum (NYS Unified Court System Division of Technology)

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MATRIMONIAL Request for Judicial Intervention Addendum
________________________ COURT, COUNTY OF ________________________ INDEX NO. ___________________________
For use when there are children under the age of 18 who are subject to the matrimonial action.
Plaintiff
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________
Prior Nam es (List any other names used, including maiden and/or former married names): Gender: G Male G Fem ale
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
Present Address: ________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
Address History
for past 3 years: ________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
Defendant
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________
Prior Nam es (List any other names used, including maiden and/or former married names): Gender: G Male G Fem ale
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
Last Nam e: _________________________ First Nam e: _________________________
Present Address: ________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
Address History
for past 3 years: ________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
Children
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________ Gender: G M G F
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________ Gender: G M G F
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________ Gender: G M G F
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________ Gender: G M G F
Last Nam e: _________________________ First Name: _________________________ Date of Birth: ________________ Gender: G M G F
U C S -840M
3/2011
Supreme
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MATRIMONIAL Request for Judicial Intervention Addendum (NYS Unified Court System Division of Technology)

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Completed 10 August 2020

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