This form contains 67 fields organized into 20 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Action Details
3. This action was brought by (circle one) petitioner/plaintiff against the respondent/defendant for [specify the nature of the action	Text	Describe the nature of the legal action. Provide details about the type of claim or dispute involved in this case.
b10d	Text	Enter additional details specifying the nature of the legal action. This field supplements the description of your claim.
b10d 9c22	Text	Provide further information regarding the nature of the action. Use this field to elaborate on your claim details.
b10d 9c22 a0b4	Text	Continue describing the nature of the legal action. This field is for additional case detail related to the claim.
b10d 9c22 a0b4 4202	Text	Enter supplemental information related to the description of the legal action. This field supports additional details about your claim.
b10d 9c22 a0b4 4202 d5e0	Text	Provide further supplementary details regarding the nature of the legal action to support your case description.
b10d 9c22 a0b4 4202 d5e0 46b9	Text	Add any extra details related to the legal action. This field allows expanding on the information about your claim.
Affirmation
I	Text	This field serves as the beginning of your personal affirmation. It may be used to state your identity or begin a declaration (e.g., 'I, ...').
2. I reside at	Text	Provide your residential address as part of your declaration (e.g., 'I reside at').
I affirm this	Text	Affirm the statement provided. Confirm that the information you have entered is true by indicating your agreement in this field.
I affirm this	Text	Acknowledge the declaration by affirming the statement provided in this section.
Appeal Success
you believe you have a good chance of success on appeal	Text	State your assessment regarding your chances of success on appeal. Clearly indicate if you believe your appeal is likely to succeed.
you believe you have a good chance of success on appeal	Text	Provide your evaluation of the likelihood of success on appeal. Describe your confidence in the appeal’s potential outcome.
you believe you have a good chance of success on appeal	Text	Indicate your opinion on the potential success of your appeal. Use this field to support your belief with relevant details.
you believe you have a good chance of success on appeal	Text	Express your judgment about the chances of success on appeal. Explain why you believe the appeal might be successful.
you believe you have a good chance of success on appeal	Text	Detail your assessment regarding the possibility of a successful appeal. Share any factors that influence your opinion.
you believe you have a good chance of success on appeal	Text	Provide your perspective on the likelihood of success on appeal. Elaborate on any supporting considerations for your belief.
you believe you have a good chance of success on appeal	Text	Enter your analysis of the potential success on appeal. This field is for detailing your confidence or reservations about the outcome.
you believe you have a good chance of success on appeal	Text	State your view regarding your chance of a successful appeal. Include any rationale that supports your assessment.
Case Information
3	Text	Provide the index number assigned to this case. This is the unique case or file identifier.
Contact Information
Name, address and phone no. of respondent or attorney	Text	Provide the full name, address, and phone number of the respondent or their attorney.
Your name, address and phone no	Text	Enter your full name, address, and telephone number for contact purposes.
Your name, address and phone no	Text	Provide your complete contact details including your name, address, and phone number.
Your name, address and phone no	Text	Enter your personal contact information: your name, mailing address, and telephone number.
d920	Text	Reiterate your full contact information including name, address, and phone number as required in this section.
Date
dated the	Date	Enter the date associated with the attached affirmation. This typically indicates when the affirmation was made.
day of	Text	Provide the day of the month on which the affirmation was executed.
20	Text	Enter the first part of the year, typically representing the century digits (e.g., '20' for the 2000s) for the date provided.
Dated	Date	Fill in the date when the document was signed or finalized.
20	Text	Enter the trailing digits for the year (if applicable), completing the date information provided.
day of	Text	Enter the day (numeric value) for the date indicated in the signing or event section.
20	Text	Enter the year or specific part of the date as required (likely the year portion), ensuring it aligns with the `day of` field.
On	Date	Provide the date associated with this section (e.g., the filing or appearance date) as indicated by the word 'On'.
20	Text	Enter the numeric component of the date (likely the year) that completes the date indicated earlier.
day of	Text	Enter the day component for the date on which this affirmation is made, as indicated by 'day of'.
Declaration
I	Text	This field contains the text 'I'. It may be part of a declaration or affirmation. Verify the context and complete as needed.
Financial Details
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide detailed financial information including amounts and sources of income, your rent obligations, and a list of any bank accounts, stocks, or other assets you own.
Financial Info
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
Set forth amount and sources of income; your rent; whether you own bank accounts, stocks	Text	Provide your income details including sources, rent expenses, and whether you hold bank accounts or own stocks.
5. Set forth amount and sources of income; your rent; whether you own bank accounts, stocks, property, a car, etc	Text	Detail your income sources and include any assets such as property, a car, and additional holdings.
property, a car, etc	Text	List or describe any assets you have (for example, property or a car) as part of your overall financial disclosure.
276f ссса	Text	This field appears to continue or reference your financial and asset details. Provide additional clarifications if needed.
276f ссса fb44	Text	This field references previous financial or asset information. Ensure consistency with the details given in related fields.
General
Motion and affirmation upon	Text
18e1	Text
(Opposing Party)	Text
Location
Avenue, New York, NY, 10010, on	Text	This field relates to location details, showing a standard address format (e.g., Avenue, New York, NY, 10010) followed by the word 'on'. Confirm or adjust as needed.
Misc
	Text	This field appears to be an extra or filler field with no explicit label. Check the form instructions for any input requirements.
Miscellaneous
3	Text	The label '3' is ambiguous. Review the associated instructions or context and provide the appropriate numeric or textual data.
Notice
PLEASE TAKE NOTICE that upon the annexed affirmation of	Text	This text introduces the notice section and references the attached affirmation. No additional input beyond confirming its context is needed.
Opposing Party
Opposing Party	Text	Enter the full name of the opposing party (individual or business) as it should appear on the form.
Parties
3e0f 2834	Text	Indicate which party initiated the action. Select whether the petitioner/plaintiff filed the case against the respondent/defendant.
Party Role
Plaintiff/Petitioner (Circle One)	Text	Select whether you are acting as the Plaintiff or the Petitioner in this case. This field requires a choice by circling the appropriate option.
Defendant/Respondent (Circle One)	Text	Select the role of the opposing party by indicating whether they are the Defendant or the Respondent.
Plaintiff/Petitioner (circle one)	Text	Again, select whether you are filing as the Plaintiff or as the Petitioner by circling the appropriate indicator.
Defendant/Respondent (circle one)	Text	Select the role of the opposing party by indicating whether they are the Defendant or the Respondent (circle one).
3e0f	Text	Select the initiating party for the action by circling whether the petitioner/plaintiff brought this action against the respondent/defendant.
Personal
a party to the action, I am over 18 years of age and I reside at	Text	Enter your residential address. This confirms that you are over 18 and a party to the action.
Recipient
To	Text	Specify the recipient of the document. Provide the name or entity to whom the notice is directed.
To	Text	Enter the recipient’s information. This may include the name or address of the party to whom this document is addressed.
Signature
Signature_0	Signature	Sign in this field to provide your official signature as required by the form.
Signature_1	Signature	Sign here to provide your signature, confirming the accuracy of your information and the statements made.

Form for Motion for Poor Person Relief Instructions