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SUPREME COURT OF THE STATE OF NEW YORKAPPELLATE DIVISION : DEPARTMENT------------------------------------------------------------------x Appellate Division- against - Case/Docket No. Originating Court No. ------------------------------------------------------------------xATTORNEY EXEMPTION CERTIFICATIONPursuant to CPLR 2111(b)(3) and 2112 and 22 NYCRR 1245.4(a)(2), I hereby certify ingood faith that I am unable to participate in the electronic filing of documents in this matter onbehalf of my client, , because: [Place your initials in the space(s) provided and check all boxes that apply] I lack:G the necessary computer hardware and/or G a connection to the internet and/orG a scanner or other device by which documents may be converted to anelectronic formatOR I lack the requisite knowledge in the operation of such computers and/or scannersnecessary to participate in electronic filing of documents in this matter, pursuant to CPLR2111(b)(3)(A) or (B).I understand that this exemption from participation in electronic filing requires that I fileand serve all court documents in hard copy and that other parties to this matter are required toserve me with documents in hard copy.I further understand that I am required submit to the court an additional unbound copy ofeach document that I file in hard copy with the court.Dated: (Signature) (Name) AD-EF-04 (eff. 3/1/18) American LegalNet, Inc. www.FormsWorkFlow.com (Firm Name) (Address) (Phone)This form must be signed. All contact information must be provided, including the address atwhich hard-copy documents in this matter should be served.This form must be filed with the clerk of the court in which the matter is pending and served onall parties. AD-EF-04 (eff. 3/1/18) American LegalNet, Inc. www.FormsWorkFlow.com