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Application To Provide Services To The Hearing Impaired Or Other Persons With Communication Disabilities - New York
| Application To Provide Services To The Hearing Impaired Or Other Persons With Communication Disabilities Form. This is a New York form and can be used in Western District Bankruptcy Court Federal . |
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UNITED STATES BANKRUPTCY COURT Western District of New York APPLICATION TO PROVIDE SERVI CES TO THE HEARING-IMPAIRED OR OTHER PERSONS WITH COMMUNICATION DISABILITIES In re: ______________________________________________________ Case No. ________________ In accordance with guidelines of this Court, application is made for Court-provided sign language interpreter and/or other appropriate auxiliary aides as follows: G Sign language interpreter G Other communication/auxiliary aid, as specified: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ For the following hearing before Judge ______________________________________________ Hearing Date/Time/Location ______________________________________________________ Applicants Role: G Debtor G Defendant G Plaintiff G Witness G Other - specify: __________________________ I certify under penalty of perjury that I am hearing impaired, deaf, or have other communication disabilities that render me eligible for receipt of these services. Date: ____________________ ____________________________________________ Applicants Signature This application must be filed with the Access Coordinator in the Clerks Office at least three weeks before the date of the hearing. In Buffalo: In Rochester: JoAnn R. Walker, Deputy-in-Charge Todd M. Stickle, Deputy-in-Charge U.S. Bankruptcy Court, WDNY U.S. Bankruptcy Court, WDNY Olympic Towers U.S. Courthouse and Federal Building300 Pearl Street, Suite 250 100 State Street Buffalo, NY 14202 Rochester, NY 14614
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