SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF : : : : : Plaintiff(s) : : : : : : : Defendant(s) : Index No. SUMMONS WITH NOTICE Designated county of trial: -against- The basis of the venue designated is: Plaintiff's address (if venue based on residence of plaintiff): Date Summons filed with the clerk of the court: To the above named defendant(s): YOU ARE HEREBY SUMMONED and required to serve upon plaintiff's attorney, at the address stated below, a notice of appearance or demand for a complaint within twenty (20) days after the service of this summons, exclusive of the day of service, or within thirty (30) days after service is complete if this summons was not personally delivered to you within the State of New York. TAKE NOTICE that this is an action for * seeking ** In case of your failure to answer, judgment will be taken against you by default for the sum of $ (if action not for medical malpractice) with interest thereon, together with the costs of this action. Dated: (Plaintiff s attorney must sign above and type name below) Defendant's(s') Address(es): Attorney(s) for Plaintiff(s) Office and Post Office Address Telephone No: *(state nature of action) ** (state relief sought) American LegalNet, Inc. www.FormsWorkflow.com