[Fill in the spaces next to the instructions. Attach copies of the indicateddocuments and mark them as exhibits. Sign your name in the presence of anotary public]SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAU----------------------------------------------------------------------------x[1. Index No. & Year] ,Index No. [2. Fill in name(s)] Plaintiff(s)/Petitioner(s) / EMERGENCY AFFIDAVIT-against- ,[3. Fill in name(s)] Defendant(s)/Respondent(s)-----------------------------------------------------------------------------xSTATE OF NEW YORK, COUNTY OF NASSAU ss: I, [4. Your name] , am the [5. Circle One]plaintiff/petitioner/defendant/respondent in the above action/special proceeding. Irequest immediate judicial review of my [6. List the document you are presenting] on the following grounds [7. Describe the reasons you need immediate relief, not the merits of your underlying case] [8. Sign your name before a Notary Public] Sworn to before me this day of , 20 [9. Print Your Name] Notary Public [10. Affidavit must be notarized] American LegalNet, Inc. www.FormsWorkFlow.com SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAU----------------------------------------------------------------------------x Index No. / EMERGENCY AFFIDAVIT [2. Fill in name(s)] -against- -----------------------------------------------------------------------------xSTATE OF NEW YORK, COUNTY OF NASSAU ss:I, , am the special proceeding. Irequest immediate judicial review of my on the following grounds Sworn to before me this day of , 20 Notary Public American LegalNet, Inc. www.FormsWorkFlow.com