SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
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[10. Index No. & Year]
,
Index No.
[11. Fill in name(s)]
Plaintiff(s)
/
-against-
,
[12. Fill in name(s)]
Defendant(s)
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[13. Insert name(s) of papers submitted]
[14. YOUR SIGNATURE]
[15. PRINT YOUR NAME]
[16. YOUR ADDRESS]
[17. CITY, STATE ZIP CODE]
[18. YOUR PHONE NUMBER]