UCS-380PVNew YorkFillable

Affirmation of Eligibility for Assigned Counsel on Appeal – Parole Violation

New York Criminal Courts · Appeals

Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗

Affirmation of eligibility for an assigned attorney on an appeal from a parole violation determination, giving the appellant's financial circumstances.

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