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Note: Multiple forms must be submitted for multiple defendants.
Note: A $200 application fee must be submitted with this form. There will be an additional $150 filing fee for any settlement negotiated with the aid of the Bais Din or for issuance of Hasraas Siruv and/or Siruv.
I have read and understand the “Din Torah Fact Sheet” and/or the sections entitled Bais Din Facts and frequently asked questions at www.queensvaad.org before initiating this Din Torah.