Affidavit in Support of Motion for Temporary Relief
Supporting a motion of temporary relief by an affiant requires the execution of the following affidavit. You also have to submit any required supporting documents.
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1 SUPREME COURT OF THE STATE OF NEW YORK 06/27/05 COUNTY OF ________________________ county in which divorce is pending ---------------------------------------------------------------x Index No. ______________ insert court index no. Plaintiff, : AFFIDAVIT IN SUPPORT -against- :OF MOTION FOR TEMPORARY RELIEF Defendant. : ----------------------------------------------------------------x STATE OF NEW YORK ) s.s.: COUNTY OF ________________________) where this affidavit is signed I, ____________________________, being duly sworn, depose and say that: your name 1. I am the ______________________ in this action for a divorce. Plaintiff/Defendant 2. I make this affidavit in support of my Motion for Temporary Relief. You may attach copies of any relevant documents in support of your case, please label and refer to them in your affidavit. BACKGROUND FACTS 3. We were married on __________________ in ________________________. date of marriage place of marriage 4. I am ______ years old and my spouse is ______ years old. age age 5. The children of the marriage are: Name of Person Child’s Name Date of Birth Social Security No. With Whom Child Resides ______________________________________________________________________________ 2 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 6. I reside at ________________________________________ and my spouse your address, or if confidential, state a mailing address resides at ______________________________________. spouse’s address 7. This action for a divorce was commenced on _________________________. A date index number was purchased copy of the Summons with Notice is attached as Exhibit A./Action is being commenced simultaneously. (complete the following sections that apply to your situation) ‘ REQUEST FOR A TEMPORARY ORDER OF PROTECTION 8. Pending the hearing of the instant application and the further Order of this Court, I request that this Court issue a Temporary Order of Protection which would order __________________________ to remain at least 150 feet away from me, my home spouse’s name and place of employment, and that ________________________ refrain from assault, stalking, spouse’s name harassment, menacing, reckless endangerment, disorderly conduct, intimidation, threats or any criminal offense against me and my family by any means, including but not limited to phone calls and other electronic means such as e-mail. 9. I believe I will be awarded an Order of Protection in this case because: (include details with names, dates and places of mental and physical abuse; include the most recent incident, the worst incident and the first incident) ______________________________________________________________________________ ______________________________________________________________________________ 3 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ‘ REQUEST FOR A TEMPORARY ORDER OF PROTECTION FOR THE CHILD(REN) 10. Pending the hearing of the instant application and the further Order of this Court, I also request that this Court issue a Temporary Order of Protection which includes protection for my child(ren), and which would order________________________to remain away spouse’s name from my child(ren), including my child(ren)’s home, school, babysitter’s home, and child care center, and that ______________________ refrain from assault, stalking, harassment, menacing, spouse’s name reckless endangerment, disorderly conduct, intimidation, threats or any criminal offense against me and my child(ren) by any means, including but not limited to phone calls and other electronic means such as e-mail. 11. The child(ren) to be covered by the Temporary Order of Protection are: Child’s Name Date of Birth ____________________________ ______________ ____________________________ ______________ ____________________________ ______________ ____________________________ ______________ 4 ____________________________ ______________ 12. I believe I will be awarded an Order of Protection that includes protection for my children in this case because: (include details with names, dates and places of mental and physical abuse; include most recent incident, worst incident and first incident) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ‘ REQUEST FOR TEMPORARY CUSTODY 13. I should have custody of the following child(ren) of the marriage, while this action is pending because: (identify the child(ren) you seek custody of and describe in detail your relationship with the children and your involvement in caring for and raising the children) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 14. It is in the child(ren)’s best interests to live with me. ‘ REQUEST FOR TEMPORARY CHILD SUPPORT 15. A copy of my Statement of Net Worth is attached as Exhibit B. It details all of my monthly expenses, income and resources. 16. Upon information and belief, my spouse’s last known income is approximately $____________ per year. My spouse works as a ___________________________________ amount spouse’s last known occupation for _____________________________________ at ________________________________ name of spouse’s last known employer address of spouse’s last employer, if known ________________________________. 17. Based upon my spouse’s income, I respectfully request an award of temporary child support in accordance with the Child Support Standards Act. ‘ REQUEST FOR VISITATION 18. I should have visitation with the child(ren) of the marriage, while the action is pending because: (identify the child(ren) you seek visitation for and describe in detail your relationship with the children and your involvement in caring for and raising the children) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 6 ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ 19. It is in the child(ren)’s best interests that I visit them on a regular basis. ‘ REQUEST FOR TEMPORARY MAINTENANCE 20. A copy of my Statement of Net Worth is attached as Exhibit B. It details all of my monthly expenses, income and resources. 21. Upon information and belief, my spouse’s last known income is approximately $__________ per year. My spouse works as a ___________________________________ amount spouse’s last known occupation for _____________________________________ at ________________________________ name of spouse’s last known employer address of spouse’s last employer, if known ________________________________. 22. As my Statement of Net Worth shows, my income is only $_________________ state your income from _____________________________________. state your source of income 23. I request an award of temporary maintenance to help me meet my monthly expenses in accordance with the standard of living that was established during the marriage. 7 ‘ REQUEST FOR MEDICAL INSURANCE AND MEDICAL EXPENSES 24. Upon information and belief, my spouse is provided through employment with medical insurance coverage for the family. 25. I ask this Court to order my spouse to continue to maintain this medical insurance coverage for me and my child(ren) during the pendency of this action. I also ask the Court to direct my spouse to provide me with the appropriate insurance identification cards, claim forms, plan description and information necessary to fully participate in the medical insurance plan. 26. In addition, I ask that the Court Order my spouse to pay the pro rata share of all medical, dental and pharmacy expenses that are not covered by insurance. ‘ REQUEST FOR LIFE INSURANCE 27. I request that the Court Order my spouse to purchase and/or maintain in full force and effect a life insurance policy on my spouse’s life in an amount sufficient to secure support obligations and naming me as the irrevocable beneficiary during the pendency of this action. 28. The life insurance policy will provide financial protection for myself and my child(ren) should my spouse die before support obligations end. ‘ REQUEST FOR EXCLUSIVE POSSESSION OF THE MARITAL RESIDENCE 29. I request exclusive possession of the marital residence located at: ________________________________________________. full address - street, apt. no, city, zip code 8 30. We lived together in the marital residence from ____________ to ____________. month & year/month & year 31. The person who currently lives is the marital residence is:___________________. name 32. I will suffer the following harm if exclusive possession of the marital residence is not awarded to me during the pendency of this action: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ‘ REQUEST FOR INJUNCTIVE RELIEF WITH RESPECT TO PROPERTY OF THE MARRIAGE 33. I request an Order that would prevent my spouse from transferring, hiding or dissipating the property of the marriage (marital assets) during the pendency of this action. 34. The marital assets include, but are not limited to, the following: (list assets accumulated during the marriage. Marital assets include, for example, houses, including rental property, cars, other vehicles, boats, household furnishings, art work, jewelry, interest in a business, bank accounts, pensions, retirement funds, tax refunds, etc.) ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 9 35. I believe that an Order that prevents my spouse from transferring, hiding or dissipating marital assets is necessary because: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 36. The property is marital property because it accumulated during the marriage, and I believe that I will ultimately be awarded an equitable share of the marital property. 37. If my spouse disposes of or hides or transfers any of the marital assets, I will be irreparably harmed because I will never be able to obtain my equitable share of the marital assets. 38. No prior application has been made for the relief requested herein. WHEREFORE, I respectfully request that my Motion be fully granted. ___________________________ sign your name Sworn to before me this______day Print name, address and telephone no. of _________,200________________________________ (THIS AFFIDAVIT MUST BE NOTARIZED) ______________________________ ______________________________
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