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