UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK CIVIL COVER SHEET This form is R EQ UIR ED for the use of the C lerk of C ourt for the purpose of initiating the civil docket sheet. Adv. Pro . No. (if applicable) IN RE: Bankruptcy Case No. Motion to Withdraw Reference, Bankruptcy Case or Proceeding MOVANTS OPPOSING PARTIES AT TO RN EY S (FIRM NA ME, ADD RE SS, T EL. NO .) ATTORNEYS (IF KNOWN) BASIS OF JURISDICTION: Federal Question CAUS E O F AC TION - 28:1334 W ithdraw al of Reference, B ankruptcy (Write brief statement of cause.) NATU RE OF SUIT: 423 Withdrawal (801) RELATED CASE(S) IN DISTRICT COURT, IF ANY DISTRICT JUDGE DOCKET NUMBER C IV IL C AS ES AR E DE E M ED R EL A TE D IF P EN D IN G C AS E I NV O L VE D : 1. PRO PER TY IN CLU DE D IN AN E ARL IER N UM BER ED PEN DIN G SU IT 2 . S AM E IS SU E O F F A CT O R GR O W S O U T O F T H E SA M E TR A NS AC T IO N 3. VALIDITY OR INFRINGEMENT OF THE SAME PATENT COPYRIGHT OR TRADEMARK Signature of Attorney of Record: [or Movant Pro Se] Date: FOR COURT USE ONLY APPLYING IFP JUDGE MAG. JUDGE American LegalNet, Inc. www.FormsWorkFlow.com CIVIL CO VER SHEE T, M otion to Withdraw Reference (cont’d) Did the cause of action arise in Nassau or Suffolk County? If YE S, plea se indicate which county: I am currently admitted in the E astern D istrict of N ew Y ork and currently a m emb er in good standing of the bar of this court. YES NO Are yo u curre ntly the subject of any disciplinary action(s) in this or any other state or federal court? YES (If yes, please explain) NO Please provide your bar code and e-mail address below. Your bar code consists of the initials of your first and last name and the last four digits of your social security number, or any other four-digit number registered by the attorney with the Clerk of Court. This information must be provided pursuant to loca l rule 11.1(b) of the local civil rules. Attorney Bar Code: E-M ail Address: USBC-84wr [r.5/24/04]] American LegalNet, Inc. www.FormsWorkFlow.com