ELECTRONIC TESTIMONY APPLICATION

FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
..........................................................................................

  Petitioner,
-against- DOCKET NUMBER
FAMILY UNIT NUMBER
  Respondent
...........................................................................................
I _____________________ acknowledge that I was served with a summons to appear in _________________ County Family Court of the State of New York located at _________________________________ .
Said summons requires my personal appearance on ___________________ at _________am/pm.

Pursuant to New York State Family Court Act § 580-316, I respectfully request that I be permitted to testify in this matter by telephone/audio-visual/other electronic means for the following reasons:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
I understand that if my application is granted it is my responsibility to arrange with the support enforcement agency in my state or the court responsible for support enforcement in my state to assist in scheduling my testimony with the New York State court. I also understand that I must confirm final arrangements for testifying by electronic means with the New York State court by calling telephone No. (518) 481-1742

DATE:________________
  ________________________
  RESPONDENT
Sworn to before me this ____
day of _________ , 200_ ________________________
  PETITIONER
____________________ _________________________
(Deputy) Clerk of the Court   Print or type name

  __________________________
Signature of Attorney, if any
  __________________________
Attorney's Name (Print or Type)
  __________________________
  __________________________
  __________________________
  Attorney's Address and Telephone Number