NOTICE OF APPEAL TO APPELLATE DIVISION, THIRD DEPARTMENT FROM ORDER/JUDGMENT OF LOWER COURT STATE OF NEW YORK COURT: COUNTY OF NOTICE OF APPEAL Plaintiff(s) , v Defendant(s) . Index No.: PLEASE TAKE NOTICE that , the (plaintiff[s] / defendant[s]) in this action, hereby appeal[s] to the Appellate Division of the Supreme Court, Third Judicial Department, from the [order / judgment] of County on the every part thereof. Dated: day of Court entered in the office of the clerk of , 20 , and from each and (Signature) (Print Name) (Address) (Telephone) TO: (name[s] and address[es] of attorney[s] for other party/parties) Note: The notice of appeal must also be filed in the office where the judgment or order of the court of original instance is entered (CPLR 5515 [1]). Revised: February 19, 2014 American LegalNet, Inc. www.FormsWorkFlow.com