SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
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[13. Index No. & Year]
,
Index No.
[14. Fill in name(s)]
Plaintiff(s)
/
-against-
,
[15. Fill in name(s)]
Defendant(s)
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[16. Insert name(s) of papers submitted]
[17. Your Signature]
[18. Your Name]
[19. Your Address]
[20. City, State & Zip Code]
[21. Your Phone Number]