Instructions: Fill in the blank spaces below following the directions given in (BOLDPRINT).Print in black ink only. SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ---------------------------------------------------------------------XIn the Matter of the Application of , [Fill in name(s)] Petitioner(s) Index No.-against- / VERIFIED PETITION , [Fill in name(s)] Respondent(s)---------------------------------------------------------------------X TO THE SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF : The petition of [YOUR NAME(S)] respectfully shows to this Court as follows: 1. Your petitioner(s) resides at [YOUR ADDRESS]. 2. The respondent(s) is/are [identify the respondent(s)] . 3. [Describe what you are asking the Court to do and all the facts concerning your claims in thisproceeding, including the underlying events and the nature of any action or decision taken by respondent(s) thatyou wish to challenge. Add more pages if needed. If you are appealing the decision of a government agency, American LegalNet, Inc. www.FormsWorkFlow.com give the date of the decision and the final determination. Explain why this Court should reverse that decision]. American LegalNet, Inc. www.FormsWorkFlow.com . 4. Attached hereto as Appendix/Appendices is/are copies of all relevant documents showingpetitioner222s right to win this case, including determination(s) issued by respondent(s) that have abearing on this case and/or of which petitioner herein complains, if any. These documents are. [IDENTIFY ALL SUCH DOCUMENTS, INCLUDING ALL WRITTEN DECISIONS OR DETERMINATIONS MADE BYRESPONDENT(S) THAT ARE PERTINENT TO THIS CASE AND ATTACH COPIES THEREOF. SEPARATELY MARKEACH SEPARATE DOCUMENT AS EXHIBIT A, EXHIBIT B, EXHIBIT C, ETC. EXPLAIN WHAT EACH EXHIBIT SHOWS]. . 5. A prior application has has not been made for the relief requested herein. [CHECKONE. CHECK THAT A PRIOR APPLICATION HAS BEEN MADE ONLY IF YOU SOUGHT THE SAME RELIEF YOUARE NOW SEEKING.] The prior application was made [DESCRIBE WHERE, WHEN, AND BY WHOM THE PRIOR APPLICATION WAS MADE, THE RESULT, AND WHY YOU ARE MAKING A SECOND APPLICATION.] American LegalNet, Inc. www.FormsWorkFlow.com . WHEREFORE, your deponent prays that this Court [DESCRIBE THE RELIEF YOU ARE REQUESTING (WHAT YOU ARE ASKING THE COURT TO DO FOR YOU)] and such other relief as the Court may find just and Dated: , New York ,200 (DATE AND COUNTY WHERE SIGNED) Petitioner (SIGN YOUR NAME IN THE PRESENCE OF A NOTARY PUBLIC) Sworn to before me on this day of , 200. Notary Public American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION , being duly sworn, deposes and says:I am the Petitioner. I have read the foregoing Petition and know thecontents thereof. The same are true to my knowledge, except as to matters therein stated to be allegedon information and belief and as to those matters I believe them to be true. To the best of myknowledge, information and belief, formed after an inquiry reasonable under the circumstances, thepresentation of these papers or the contentions therein are not frivolous as defined in subsection (c) ofsection 130-1.1 of the Rules of the Chief Administrator (22 NYCRR). [SIGNED] [TYPED]Sworn to before me this day of , 200 . Notary Public American LegalNet, Inc. www.FormsWorkFlow.com