Here is the text we could read:
DEKLARASYON SOU SÈMAN
MOUN KI FÈ PLENT
POU SIPÒTE DEMANN POU YON
LÒD SIPÒ TIMOUN
NIMEWO REJIS (POU TRIBINAL LA ITILIZE SÈLMAN)
TRIBINAL PREMYE ENSTANS
MASSACHUSETTS
NON MOUN KI FÈ PLENT LAN
NON AKIZE A
DIVIZYON TRIBINAL LA
Mwen,
mwen konnen ak kwè:
, deklare oswa konfime enfòmasyon ki anba la yo se enfòmasyon ki vrè dapre tout sa
. Akize a se manman/papa (fè wonn nan youn) epi mwen se responsab legal timoun sa (yo).
2. Akize a ap travay kòm yon
Akize a travay pou
ki gen adrès li ki se
.
,
.
3. Revni anvan dediksyon ak depans mwen yo prezante konsa:
Revni Brit (revni anvan taks)
Mwen fè
$ _______ pa semèn/mwa (fè wonn nan youn).
sirans Sante
sirans pou dan ak/oswa vizyon
Mwen peye $ _______ pa semèn/mwa (fè wonn nan youn).
Mwen peye $ _______ pa semèn/mwa (fè wonn nan youn).
epans mwen pou gadri pou timoun (yo) ki endike nan Pati 1 Mwen peye $ _______ pa semèn/mwa (fè wonn nan youn).
òt obligasyon sipò timoun
Mwen peye $ _______ pa semèn/mwa (fè wonn nan youn).
. Dapre sa mwen konnen, revni brit akize a ak depans li yo prezante konsa:
Revni brit (revni anvan taks)
sirans sante
sirans dan ak/oswa zye
epans gadri akize a fè pou timoun (yo) ki
endike nan Pati 1
Li fè
Li peye
Li peye
$ _______ pa semèn/mwa (fè wonn nan youn).
$ _______ pa semèn/mwa (fè wonn nan youn).
$ _______ pa semèn/mwa (fè wonn nan youn).
Li peye
$
_ pa semèn/mwa (fè wonn nan youn).
òt obligasyon pou peye sipò timoun
Li peye
$ _______ pa semèn/mwa (fè wonn nan youn).
A
A
D
L
A
A
D
L
1
4
□ Mwen deklare enfòmasyon ki anwo a se enfòmasyon ki vrè, epi mwen siyen yo anba sanksyon pou fo temwayaj.
NON MOUN KI FÈ PLENT LAN AN LÈT DETACHE
SIYATI MOUN KI FÈ PLENT LAN
FA-11 (1/12) Plaintiff’s Affidavit in Support of a Request for a Child Support Order – Haitian Creole (06/14)
DAT (mwa/jou/ane)
This form is for your reference only. Do not submit to the court. Fòm sa a la sèlman pou referans. Pa remèt li nan tribunal la.
Kreyòl ayisyen
This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts.
To learn more about the project, check out our about page.
Downloads: You can download both the original form (last checked 2023-03)
and the machine-processed form with normalized data fields.
About This Form:
- Sourced from www.mass.gov (2023-03)
- Page(s): 1
- Fields(s): 18
- Average fields per page: 18
- Reading Level: Grade 7
- LIST Grouping(s):
Unknown
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Identified Data Fields:
We have done our best to automaticly identify and name form fields according to our naming conventions.
When possible, we've used names tied to our question library. See e.g., user1_name.
If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.
Here are the fields we could identify.
mwen
was mwen (0.97 conf)ki_la_se_vr_tout_sa
was deklare_oswa_konfime_enfòmasyon_ki_anba_la_yo_se_enfòmasyon_ki_vrè_dapre_tout_sa (0.56 conf)se_papa_nan_epi_sa_yo
was 1_akize_a_se_manman_papa__fè_wonn_nan_youn__epi_mwen_se_responsab_legal_timoun_sa__yo (0.50 conf)page_field__1
was page_0_field_3 (0.31 conf)akize_ap_travay_k_yon
was 2_akize_a_ap_travay_kòm_yon (0.56 conf)af_f
was AFF005 (0.51 conf)page_field__2
was page_0_field_6 (0.31 conf)mwen_peye
was mwen_peye (0.35 conf)pa_sem_n_mwa_f_nan_youn
was pa_semèn_mwa__fè_wonn_nan_youn (0.46 conf)page_field__3
was page_0_field_9 (0.31 conf)page_field__4
was page_0_field_10 (0.31 conf)page_field__5
was page_0_field_11 (0.31 conf)page_field__6
was page_0_field_12 (0.31 conf)l_sip_timoun
was lòd_sipò_timoun (0.35 conf)non_moun_ki_f_plent_lan
was non_moun_ki_fè_plent_lan (0.42 conf)page_check__1
was page_0_check_2 (0.33 conf)page_check__2
was page_0_check_3 (0.33 conf)form_reference_sub_mit_court
was t_his_form_is_for_your_reference_only__d_o_not_sub_mit_to_the_court (0.46 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
mwen
mwen_peye
l_sip_timoun
form_reference_sub_mit_court
Suggested Screen 1:
Suggested Screen 2:
Suggested Screen 3:
page_field__1
page_field__2
page_field__3
page_field__4
page_field__5
page_field__6
page_check__1
page_check__2
Suggested Screen 4:
se_papa_nan_epi_sa_yo
akize_ap_travay_k_yon
pa_sem_n_mwa_f_nan_youn
non_moun_ki_f_plent_lan
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