[Fill in the spaces next to the instructions. Other spaces are for Court use.]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) / NOTICE OF APPEAL-against- ,[3. Fill in name(s)]Defendant(s)/Respondent(s)-----------------------------------------------------------------------------xTo the Person (s) Named as Defendant(s) above: PLEASE TAKE NOTICE THAT [4. Insert Your Name] hereby appeals to the Appellate Division of the Supreme Court of the State of New York, from a [5. Insert Judgment/ Order/ Decree] of the [6. Insert Name of Court] , Court, Nassau County, dated [7. Insert date of Judgment/ Order/ Decree] .[8. Date and County papers are signed in] Dated: County: [9. Your Signature] [10. Your Name] [11. Your Address] [12. City, State & Zip Code] [13. Your Phone Number] American LegalNet, Inc. www.FormsWorkFlow.com To: [Insert Below the Names, Addresses and Phone Numbers of All Opponents andtheir attorneys, if any. Use Additional Sheets of paper, if needed. An original of thisnotice of appeal must be filed with the Nassau County Clerk and copies must bemailed to all opponents by first class mail.] American LegalNet, Inc. www.FormsWorkFlow.com SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAU----------------------------------------------------------------------------x [1. Index No. & Year]Index No. / NOTICE OF APPEAL ,[3. Fill in name(s)]Defendant(s)/Respondent(s)-----------------------------------------------------------------------------xTo the Person (s) Named as Defendant(s) above:PLEASE TAKE NOTICE THAT [4. Insehereby appeals to the Appellate Division of the Supreme Court of the State of New York,from a of Court, NassauCounty, dated .Dated: County: -against- American LegalNet, Inc. www.FormsWorkFlow.com To: American LegalNet, Inc. www.FormsWorkFlow.com