Supreme Court of the State of New York Appellate Division: Second Judicial Department John Doe, Plaintiff-Appellant, Appellate Division Docket No.: -against- ________________________ ABC Corporation, Defendant-Respondent. (Do not change the order of the parties in the title from that on the summons or petition.) STATEMENT PURSUANT TO CPLR 5531 1. The Index Number in the trial court was 9876/98 2. The full names of the parties are set forth above. There have been no changes. 3. The action was commenced in the Supreme Court, Kings County. 4. The summons and complaint were served on January 8, 1998. The answer was served on February 2, 1998. 5. The object of the action is to recover damages for personal injuries arising out of an automobile accident. 6. The appeal is from an order of the Supreme Court, Kings County dated March 2, 1998, and entered March 3, 1998, made by Justice Smith. 7. The appeal is being perfected on the full record method. American LegalNet, Inc. www.FormsWorkFlow.com Supreme Court of the State of New York Appellate Division: Second Judicial Department Plaintiff-Appellant, Appellate Division Docket No.: -against- ________________________ Defendant-Respondent. (Do not change the order of the parties in the title from that on the summons or petition.) STATEMENT PURSUANT TO CPLR 5531 1. The Index Number in the trial court was . 2. The full names of the parties are set forth above. There have been no changes. 3. The action was commenced in the Supreme Court, Kings County. 4. The summons and complaint were served on , 20 . , 20 . The answer was served on 5. The object of the action is . 6. The appeal is from and entered of the Supreme Court, Kings County dated , 20 , made by Justice . , 20 , 7. The appeal is being perfected on . American LegalNet, Inc. www.FormsWorkFlow.com CPLR 5531 Description of action. The appellant shall file together with the record on appeal,in both criminal and civil actions, a statement containing the following information listed and numbered in the following order: 1. the index number of the case in the court below, 2. the full names of the original parties and any change in the parties, 3. the court and county in which the action was commenced, 4. the date the action was commenced and the dates on which each pleading was served, 5. a brief description of the nature and object of the action, 6. a statement as to whether the appeal is from a judgment or an order or both, the dates of entry of each judgment or order appealed from, and the name of the judge or justice who directed the entry of the judgment or made the order being appealed, and 7. a statement as to the method of appeal being used: (a) whether the appeal is on a full record, printed or reproduced, or (b) on the original record, in which event, state whether the appendix method is being used, or leave to prosecute the appeal on the original record was granted by the court or by statute. The statement shall be prefixed to the papers constituting the record on appeal. A copy of this statement shall be filed with the clerk at the time the record on appeal is filed. American LegalNet, Inc. www.FormsWorkFlow.com