CIVIL COURT OF THE CITY OF NEW YORK
APPLICATION FOR A SUMMONS
PARTIES
PLAINTIFF: Please print your name, complete address, including your apartment number (no P.O. box number) and
telephone number. [Please note: If the claim is based on an auto accident, the claim must be Owner against Owner].
A Corporation must be represented by an attorney.
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DEFENDANT(S): Please print the full legal name and street address (no P.O. box number) of the party(ies) you are
suing. Indicate whether you are suing this party as a person or a business. [Please note: If you are suing a business,
indicate whether it is a partnership, a corporation or an individual with a business certificate. This information can be
obtained in the County Clerk’s Office in the county in which the business is located. Failure to check this information
may result in a judgment which cannot be executed.]
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CLAIM
REASON FOR CLAIM:
G automobile
G person
G property other than automobile
Damage cause to:
G repairs
G proper service
G goods ordered
Failure to provide:
G security
G property
G deposit
G money
Failure to return:
G wages
G services rendered
G insurance claim G money loaned
Failure to pay for:
G rent
G commissions
G goods sold and delivered
G contract
G lease
Breach of:
G luggage
G property
G time from work
G use of property
Loss of:
G check (bounced)
G merchandise (not reimbursed)
Returned:
Other: (Be brief)
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DETAILS OF CLAIM:
Amount of Claim: (Limit $25,000 for each Cause of Action) $___________________
Date of Occurrence: ____________________________________________________________
Place of Occurrence: ____________________________________________________________
If Car Accident: YOUR license plate #________________ DEFENDANT’S license plate # ______________
Identifying Number(s):____________________________________________________________________
(Receipt #, Claim #, Account #, Policy #, Ticket #, etc.)
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X________________________________________________
Date
Signature of Plaintiff
CIV-GP-59 (Revised 7/10)