INSTRUCTIONS Please fill in the underlined spaces on the following form with answers appropriate to your motion. Motions are returnable in this Court on a Monday (or if a Monday falls on a holiday, on the next business day). You must give 13 days' notice (prior to the return date) if you serve your adversary (or adversaries) by mail or eight days' notice if you use personal service. Return the original motion papers to this office (addressed to Supreme Court, Appellate Division, Third Judicial Department, P.O. Box 7288, Capitol Station, Albany, NY 12224-0288), serve your adversary (or adversaries) with one copy, and provide this office with proof of service. If any adversary is represented by an attorney, service should be made upon the attorney rather than the adversary. You should attach to your papers a copy of your notice of appeal, a copy of the order or judgment appealed from, and a copy of the written decision upon which the order or judgment was based. Unless you have previously been granted permission to proceed as a poor person by this Court, you must also enclose with the original motion papers either a bank check or money order (made payable to the State of New York) in the amount of $45 as payment of the motion filing fee or a motion for permission to proceed as a poor person. Revised: February 19, 2014 1 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF NEW YORK APPELLATE DIVISION SUPREME COURT THIRD DEPARTMENT , , MOTION FOR v Appellate Division Case No. , . PLEASE TAKE NOTICE that, upon the annexed affidavit, sworn to the , 20__ the City of Albany, New York, on the order (Specify relief which you seek.): day of , a motion will be made at a term of this Court to be held in day of , 20 , for an _____________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Dated: (Signature) (Print Name) (Address) (Telephone) PLEASE TAKE NOTICE that, pursuant to section 800.2 (a) of the Rules of this Court, this motion will be submitted on the papers, and the personal appearance of counsel or the parties is neither required nor permitted. Revised: February 19, 2014 2 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT IN SUPPORT OF MOTION STATE OF NEW YORK COUNTY OF ss.: , being duly sworn, deposes and says: 1. I am the in the above-entitled action. I have appealed to the Appellate Division from an order or judgment of the Court of (Specify the status of the appeal.) ______________________________________________________________________________ County, dated . 2. By this motion I seek the following relief: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. The grounds for the motion and reasons the relief should be granted are (Attach additional documentation, if necessary) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (Signature) (Print Name) Sworn to before me this day of , 20 . Notary Public Revised: February 19, 2014 3 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT OF SERVICE OF MAILING STATE OF NEW YORK COUNTY OF ) ) ss.: , being duly sworn, deposes and says: On the day of , 20 , I served a true copy of the annexed notice of motion and supporting affidavit by mailing the same in a sealed envelope, with postage prepaid thereon, in a post office or official depository of the U.S. Postal Service within the State of New York, addressed to the last known addressee(s) as indicated below: (Insert here the name[s] and address[es] of the person[s] to whom you are mailing the papers being filed with this Court. If necessary, attach extra pages for additional nam es and addresses.) Name & Address Name & Address (Signature) (Print Name) Sworn to before me this day of , 20 . Notary Public American LegalNet, Inc. www.FormsWorkFlow.com Revised: February 19, 2014 4