Form Ucs-840a - Request For Judicial Intervention Addendum
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Request for Judicial Intervention Addendum
UCS-840A (3/2011)
Supreme
Albany
________________________COURT,
COUNTY OF__________________________
Index No: ________________________
For use when additional space is needed to provide party or related case information.
PARTIES:
For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail address in "Attorneys" space.
Parties:
Attorneys
:
Issue
Un-
List parties in caption order and
Joined
Insurance Carrier(s):
Provide name, firm name, business address, phone number and e-mail
Rep
indicate party role(s) (e.g. defendant;
(Y/N):
address of all attorneys that have appeared in the case.
3rd-party plaintiff).
Last Name
Last Name
First Name
G
YES
G
First Name
Firm Name
Primary Role:
Alabama
Plaintiff
Street Address
City
State
Zip
G
NO
Secondary Role (if any):
Plaintiff
Phone
Fax
e-mail
Last Name
Last Name
First Name
G
YES
G
First Name
Firm Name
Primary Role:
Alabama
Plaintiff
Street Address
City
State
Zip
G
NO
Secondary Role (if any):
Plaintiff
Phone
Fax
e-mail
Last Name
Last Name
First Name
G
YES
G
First Name
Firm Name
Primary Role:
Alabama
Plaintiff
Street Address
City
State
Zip
G
NO
Secondary Role (if any):
Plaintiff
Phone
Fax
e-mail
Last Name
Last Name
First Name
G
YES
G
First Name
Firm Name
Primary Role:
Alabama
Plaintiff
Street Address
City
State
Zip
G
NO
Secondary Role (if any):
Plaintiff
Phone
Fax
e-mail
Last Name
Last Name
First Name
G
YES
G
First Name
Firm Name
Primary Role:
Alabama
Plaintiff
Street Address
City
State
Zip
G
NO
Secondary Role (if any):
Plaintiff
Phone
Fax
e-mail
Last Name
Last Name
First Name
G
YES
G
First Name
Firm Name
Primary Role:
Alabama
Plaintiff
Street Address
City
State
Zip
G
NO
Secondary Role (if any):
Plaintiff
Phone
Fax
e-mail
RELATED CASES:
List any related actions. For Matrimonial actions, include any related criminal and/or Family Court cases.
Case Title
Index/Case No.
Court
Judge (if assigned)
Relationship to Instant Case
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Parent category: Legal