______________ COURT OF THE STATE OF NEW YORK COUNTY OF_____________________________ _____________________________________________, Plaintiff(s), against _____________________________________________, Defendant(s). REDACTION COVER PAGE Index No. _______________ ( , J.) __________________ __________________ ( ) The document filed contains no confidential personal information, as defined in 22 NYCRR 202.5(e). ) The document contains the following (CHECK ANY THAT APPLY): ( ( ( ( ) Social Security Number. ) Confidential Personal Information (CPI) that is REDACTED in accordance with 22 NYCRR 202.5(e). ) Confidential Personal Information (CPI) that is UN-REDACTED and seeks a remedy in accordance with 22 NYCRR 202.5(e)(2) OR (3). ) Confidential Personal Information (CPI) that is UN-REDACTED as required or permitted by a specific rule or law; Specify the rule or law _____________________________________ . ( ) Confidential Personal Information (CPI) that is UN-REDACTED as directed by court order; and I hereby specify: DATE of such court order: _______ & DATE filed: ___________. Other identifying information for such order: ___________________ . ( Does the court order direct that this UN-REDACTED document be visible to all participating parties? ( ) yes / ( ) no. A court order is being filed with the document: ( )yes / ( ) no. Signature of filer:_________________________________________ Print Name:_________________________________________ Counsel appearing for: ____________________________________(name of party) Filer is Unrepresented: Date:_______________ yes no Revised 01/2016 American LegalNet, Inc. www.FormsWorkFlow.com