UNITED STATES DISTRICT COURT Form 2WESTERN DISTRICT OF NEW YORK , Plaintiff, M OTION FOR AN EXTENSION OF TIME v. TO FILE A NOTICE OF APPEAL , ________-CV-_________ Defendant(s). Pursuant to Fed.R.App.P. 4(a)(5), ___________________________________[print your name], respectfully requests leave to file the attached Notice of Appeal out of time. _________________________ [ identify yourself as plaintiff or defendant in the district court action]desires to appeal the decision in this action which was entered on ________________, 20____, but failed to file a notice of appeal within the required number of days because : [Tell the Court what the excusable neglect/good cause led to your failure to file an appeal within the required number of days. ] ________________________________________________________ ______________________________________________________________________________ _________________________________________________________________________________ Dated: _________________, 20___ Signature Print Your Name Appearing Pro Se Address: _______________________________________ _______________________________________ Telephone: _____________________________________