Form Ud 6 PDF Details

Form Ud 6 is an information form used to collect data about a person's race and ethnicity. The form is used by the U.S. Census Bureau to help track demographic trends in the United States. The information collected on Form Ud 6 is also used to enforce anti-discrimination laws and policies. The form can be completed online or by mail, and must be filled out by everyone aged 16 or older who lives in the United States. Accuracy is vital when completing this form, so please take your time to provide accurate responses. Thank you for your cooperation!

QuestionAnswer
Form NameForm Ud 6
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesaffidavit plaintiff, occurred defendant immediately, affidavit of plaintiff uncontested divorce, new york plaintiff

Form Preview Example

SUPREME COURT OF THE STATE OF NEW YORK

1COUNTY OF

2

--------------------------------------------------------------------

 

 

X

 

 

 

 

 

 

3

 

 

 

Plaintiff,

Index No.:

 

 

-against-

 

AFFIDAVIT OF PLAINTIFF

4

 

 

 

Defendant.

 

 

 

 

 

 

 

 

5

STATE--------------------------------------------------------------------OF

}

X

 

 

 

 

 

 

ss:

 

 

 

COUNTY OF

 

}

 

 

6______________________________ being duly sworn, says:

71. The Plaintiff’s address is

 

 

, and social security number is

 

 

. The Defendant’s address is

 

 

 

 

 

 

 

 

 

, and social security number is

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

Plaintiff

 

 

 

 

 

 

8

2.

A)

 The

has resided in New York State for a continuous period of at least

Defendant

two years immediately preceding the commencement of this divorce action.

================================OR===============================

B)  The

Plaintiff

resided in New York State on the date of commencement of this

 

Defendant

 

divorce action and for a continuous period of one year immediately preceding the commencement of this divorce action.

AND:

a. the parties were married in New York State. or

b. the parties have resided as married persons in New York State.

================================OR================================

Plaintiff

C) The cause of action occurred in New York State and Defendant resided in New

York State for a continuous period of at least one year immediately preceding the commencement of this divorce action.

================================OR================================

D) The cause of action occurred in New York State and both parties were residents at the time of commencement of this divorce action.

(Form UD-6 Rev. 1/13)

________________________________________________
________________________________________________
________________________________________________
Present Address
________________________________________________
________________________________________________
________________________________________________
Other Address Within Last 5 years
________________________________________________
________________________________________________
________________________________________________

93. 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.

10(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).

114. There is (are) _____ child(ren) of the marriage under the age of 21 (see definition on page 7 of the Instructions)

Name & Social Security Number

 

Date of Birth

_______________________________________

_______________

_______________________________________

_______________

_______________________________________

_______________

 

 

 

 

 

 

The present address of each minor child of the marriage under the age of 18 (see definition on page 7 of the Instructions) and all other places where each child has lived within the last five (5) years is as follows:

Child

___________________

___________________

___________________

Child

___________________

___________________

___________________

The name(s) and present address(es) of the person(s) with whom each minor child of the marriage under the age of 18 (see definition on page 7 of the Instructions) has lived within the last five (5) years is:

___________________

___________________

___________________

12I have participated in other litigation concerning the custody of the minor child(ren) of the

(Form UD-6 Rev. 1/13)

marriage (see definition on page 7 of the Instructions) in this or another state. Yes  No  I have information of a custody proceeding concerning the minor child(ren)of the marriage (see definition on page 7 of the Instructions) 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 minor child(ren) of the marriage (see definition on page 7 of the Instructions) or claims to have custody or visitation rights with respect to such child(ren). Yes  No 

13The parties are covered by the following group health plans:

Plaintiff

 

Defendant

Group Health Plan:

 

 

Group Health Plan:

 

Address:

 

 

Address:

 

Identification Number:

 

 

 

Identification Number:

 

Plan Administrator:

 

 

 

Plan Administrator:

 

Type of Coverage:

 

 

Type of Coverage:

 

 

OR

 Not Applicable.

 No health plans are available to the parties

 

through their employment

145. The grounds for dissolution of the marriage are as follows:

Cruel and Inhuman Treatment (DRL §170(1)):

At the following times Defendant committed the following act(s) which endangered the Plaintiff’s physical or mental well being and rendered it unsafe or improper for Plaintiff to continue to reside with Defendant.

(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)

(Form UD-6 Rev. 1/13)

(Form UD-6 Rev. 1/13)

14continued

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.

 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 spouse, 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)):

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 is/was confined in prison on the

Name of correctional facility

 

 

______day of ___________,____, and

remained confined until the

Month

Year

OR remains confined to this date.

______day of_____________,____;

Month

Year

 

Adultery (DRL §170(4)):

That on the___ day of___________,____, at ______________________________

Month

Year

Location

the Defendant voluntarily committed of an act of sexual or deviate sexual intercourse with a person other than the Plaintiff after the marriage of Plaintiff and Defendant.

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

(Form UD-6 Rev. 1/13)

judgment.

14continued

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.

Irretrievable Breakdown in Relationship for at Least Six Months (DRL §170(7)):

That the relationship between Plaintiff and Defendant has broken down irretrievably for a period of at least six months.

15

6a.

In addition to the dissolution of the marriage, I am seeking the following ancillary relief:

The nature of any ancillary or additional relief requested (see p.19 of Instructions) is:

______________________________________________________________________________________

________________________________________________________________

Additional page describing ancillary relief requested is attached;

Marital property to be distributed pursuant to separation agreement/stipulation;

I waive distribution of Marital property;

NONE- I am not requesting any ancillary relief;

AND any other relief the court deems fit and proper

6b.

If DRL §170 subd. (7) is the ground alleged, then Plaintiff hereby affirms, by checking the Box A, B, or C or D below (NOTE: BOX A, B, C or D below must be checked if DRL 170(7) is the ground alleged), that the following statement is true:

All economic issues of equitable distribution of marital property, the payment or waiver of spousal support, the payment of child support, the payment of counsel and experts' fees and expenses as well as the custody and visitation with the minor children of the marriage:

A. have been resolved by the parties and are to be incorporated into the Judgment of Divorce.

by oral settlement/ stipulation on the record; or

by written Settlement/ Separation Agreement

B. will be determined by the Court and are to be Incorporated into the Judgment of Divorce.

C. were determined by Family Court order (custody and visitation or child support and/ or spousal support issues only) which will be continued.

D. are not to be incorporated into the Judgment of Divorce, since neither party to the divorce has contested any such issues.

(Form UD-6 Rev. 1/13)

16 7. The Defendant is in the military service and has

waived his

rights under the New York State

has not

her

 

Soldiers’ and Sailors’ Civil Relief Act.

 

 

================================OR================================

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.

178. I am not receiving Public Assistance. To my knowledge the Defendant is not receiving Public Assistance.

189. 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.

19 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.

2011A.  I am not the custodial parent of the unemancipated child(ren) of the marriage (see definition on page 7 of the Instructions).

OR

11B.  I am the custodial parent of the unemancipated child(ren) of the marriage (see definition on page 7 of the Instructions) 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 (also known as an Income Withholding Order/Notice for Support) 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) is selected, the Support Collection Unit Information Sheet (Form UD-8a) should be completed and presented with your papers.

(Form UD-6 Rev. 1/13)

21Plaintiff’s OR Defendant’s prior surname is: Pursuant to DRL § 240 1 (a-1) Records Checking Requirements:

An Order of Protection  has been has never been issued against me, enjoining me or requiring my compliance.

An Order of Protection  has has never been issued in favor of or protecting me or my child(ren)

or a member of my household.

List all Family/Criminal Court Docket #’s and Counties,

____________________________

Supreme Court Index #’s and Counties

____________________________

I or my child(ren) or my spouse has been named in a Child Abuse/Neglect Proceeding (FCA Art.10)

List all Family Court Docket #’s

____________________________

and Counties

____________________________

I or my child(ren) or my spouse has never been named in a Child Abuse/Neglect Proceeding (FCA Art.10)

I am registered under New York State’s Sex Offender Registration Act

List all names under which

____________________________

you are registered

____________________________

I am not registered under New York State’s Sex Offender Registration Act

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.

22Subscribed and Sworn to before me on

Plaintiff’s Signature

NOTARY PUBLIC

(Form UD-6 Rev. 1/13)

(Form UD-6 Rev. 1/13)

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