On March 26, 2024 a
Miscellaneous
was filed
involving a dispute between
Mackenzie Rose Dowling,
and
None,
for Other Matters - Name Change/Sex Designation Change
in the District Court of Suffolk County.
Preview
FILED: SUFFOLK COUNTY CLERK 03/26/2024 09:26 AM INDEX NO. 607387/2024
NYSCEF DOC. NO. 3 New York State Unified Court System nycourts.gov
RECEIVED NYSCEF: 03/26/2024
UCS-FW1 07/2023
Affidavit in Support of Application
to Waive Court Fees and Costs nycourthelpoov
Court .
County of S 1k.
In the matter of:
c4te doM Dra^3 Index Nurnber:
Plaintiff/Petitioner (party bringing case) or Subject of Proceeding
-against-
Defendant/Respondent (opposing party; if none, leave blank) .
State of New York, County of 5uMo %
I, 04.tKL4t od( A0%ts , being duly sworn, says:
1. I am a party in this case.
2. I live at 724 Meaâg kw\A Gc\\ ir \\~l6
3. I have the following: [Check all that apply]
¡ Income Source: Monthly Amount:
¡ Public Assistance $
¡ Spousal Support $ .
¡ Social Security/SSI/SSID $
21Wages . $ 603 44
¡ Other: $ .
¡ Bank Type: Balance:
Account(s 5 $
Ed Checking $
2•Savings $ 9.o0 34
¡ Real Estate Address: . Market Value:
$
¡ Personal Description: Value:
Property $
4. I request a court order: [Choose one of the following]
5( Waiving and all court filing fees for this case
any
¡ Waiving the filing fee for a Notice of Appeal
¡ Other (specify):
5. I make this application based on CPLR §1101. I do not have and cannot get the funds to pay the
necessary costs, fees, and expenses. I cannot proceed unless the order is granted.
ADA Accommodations Spoken or Sign Language Interpreters , 1-800-COURT-NY
ada@nycourts.qov interpreter@nycourts.qov (268-7869)
1 of 2
FILED: SUFFOLK COUNTY CLERK 03/26/2024 09:26 AM INDEX NO. 607387/2024
NYSCEFUCS±FW1
DOC. NO.(07/2023)
3 Page 2 of 2 Index/File Number: RECEIVED NYSCEF: 03/26/2024
6. The facts of my case are: [Choose one of the following]
explained in my attached.court papers.
[id as follows: Im g Sun time cou s+chedc ok 7ohn co\\e of Cr
I¯
Tus¾c c owicL T e.3or ad - tirwe. ~92 .Sor 4ranyof n otS
o^orO Ae- fr**S ·
IAI¬fj as
School. 3 o
9 Sfed due
7. No other person who may benefit from the outcome of this case is able to pay such costs, fees,
and expenses.
8. [Choose one of the following]
2Í I have not previously applied to waive the court fees and costs in this case.
¡ I have previously applied to waive the court fees and costs in this case, but I am applying
again because:
Signature in Presenc f Notary
Sworn to before me this 6
day of ModrtlN 20 2_q_.
Notary Public
Note: Contact the court and ask if you are required to submit any additional documentation and/or if
you are required to serve any other party.
BONNIE CLAIRE ZELLNER
NorARY PUBLIC, STATE OF NEW YORK
Registration No. OlZE6424367
Qualified in Suffolk Count
My Commission Expires // /5 l 5
2 of 2
Preview
FILED: SUFFOLK COUNTY CLERK 03/26/2024 09:26 AM INDEX NO. 607387/2024 NYSCEF DOC. NO. 3 New York State Unified Court System nycourts.gov RECEIVED NYSCEF: 03/26/2024 UCS-FW1 07/2023 Affidavit in Support of Application to Waive Court Fees and Costs nycourthelpoov Court . County of S 1k. In the matter of: c4te doM Dra^3 Index Nurnber: Plaintiff/Petitioner (party bringing case) or Subject of Proceeding -against- Defendant/Respondent (opposing party; if none, leave blank) . State of New York, County of 5uMo % I, 04.tKL4t od( A0%ts , being duly sworn, says: 1. I am a party in this case. 2. I live at 724 Meaâg kw\A Gc\\ ir \\~l6 3. I have the following: [Check all that apply] ¡ Income Source: Monthly Amount: ¡ Public Assistance $ ¡ Spousal Support $ . ¡ Social Security/SSI/SSID $ 21Wages . $ 603 44 ¡ Other: $ . ¡ Bank Type: Balance: Account(s 5 $ Ed Checking $ 2•Savings $ 9.o0 34 ¡ Real Estate Address: . Market Value: $ ¡ Personal Description: Value: Property $ 4. I request a court order: [Choose one of the following] 5( Waiving and all court filing fees for this case any ¡ Waiving the filing fee for a Notice of Appeal ¡ Other (specify): 5. I make this application based on CPLR §1101. I do not have and cannot get the funds to pay the necessary costs, fees, and expenses. I cannot proceed unless the order is granted. ADA Accommodations Spoken or Sign Language Interpreters , 1-800-COURT-NY ada@nycourts.qov interpreter@nycourts.qov (268-7869) 1 of 2 FILED: SUFFOLK COUNTY CLERK 03/26/2024 09:26 AM INDEX NO. 607387/2024 NYSCEFUCS±FW1 DOC. NO.(07/2023) 3 Page 2 of 2 Index/File Number: RECEIVED NYSCEF: 03/26/2024 6. The facts of my case are: [Choose one of the following] explained in my attached.court papers. [id as follows: Im g Sun time cou s+chedc ok 7ohn co\\e of Cr I¯ Tus¾c c owicL T e.3or ad - tirwe. ~92 .Sor 4ranyof n otS o^orO Ae- fr**S · IAI¬fj as School. 3 o 9 Sfed due 7. No other person who may benefit from the outcome of this case is able to pay such costs, fees, and expenses. 8. [Choose one of the following] 2Í I have not previously applied to waive the court fees and costs in this case. ¡ I have previously applied to waive the court fees and costs in this case, but I am applying again because: Signature in Presenc f Notary Sworn to before me this 6 day of ModrtlN 20 2_q_. Notary Public Note: Contact the court and ask if you are required to submit any additional documentation and/or if you are required to serve any other party. BONNIE CLAIRE ZELLNER NorARY PUBLIC, STATE OF NEW YORK Registration No. OlZE6424367 Qualified in Suffolk Count My Commission Expires // /5 l 5 2 of 2