Civil Court of the City of New York County of Index Number Part Claimant(s)/Plaintiff(s)/Petitioner(s), NOTICE OF APPEAL -against- Defendant(s)/Respondent(s) - PLEASE TAKE NOTICE that the Appellant, hereby appeals to the Appellate Term of the Supreme Court, First/Second Department, from Strike one the Order/Judgment by the Hon. Strike one Judge of the Civil/Housing Court of the City of New York, entered in the office of the Clerk of Strike one said Court on , and from each and every part thereof. Dated: Appellants Signature: Appellants Name: To: Address: Appellants Phone: CIV-GP-67A (Revised October, 2003) American LegalNet, Inc. www.USCourtForms.com