SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
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[21. Index No. & Year]
,
Index No.
[22. Fill in name(s)]
Plaintiff(s)
/
-against-
,
[23. Fill in name(s)]
Defendant(s)
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[24. Insert name(s) of papers submitted]
[25. YOUR SIGNATURE]
[26. PRINT YOUR NAME]
[27. YOUR ADDRESS]
[28. CITY, STATE ZIP CODE]
[29. YOUR PHONE NUMBER]