__________ COURT OF THE STATE OF NEW YORK
COUNTY OF ____________
PRO BONO AFFFIRMATION
Index No: __________
_____________________________, Esq., pursuant to CPLR §2106 and under
penalty of perjury, affirms as follows:
1. I am an attorney at law duly licensed to practice in the state of New York and am
representing _______________________ , who is/are the _________________
in the above captioned action.
2. I submit this affirmation together with court papers prepared using the New York
State Unified Court System’s DIY (Do-It-Yourself) Form Program.
3. I understand that commercial use of the DIY Form Programs is prohibited. I
understand that the DIY Form programs are only for use of litigants representing
themselves, legal services providers, or pro bono attorneys.
4. I agreed to these terms when I signed on to the website to use the DIY Form
5. With the exception of any court mandated filing fees, I am representing my
client(s) in this case on a pro bono basis.
6. I have informed my client(s), that use of the DIY Form Program is free and that I
am not permitted to charge a fee in this case.