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State of New York - Court of Claims ____________________________________________, Claimant(s), -against____________________________________________, Claim No. Defendant(s). CHECK ALL THAT APPLY: REDACTION COVER PAGE The document filed contains no confidential personal information, as defined in 22 NYCRR 206.5(e). The document filed is REDACTED in accordance with 22 NYCRR 206.5(e) . The document filed is UN-REDACTED in accordance with 22 NYCRR 206.5(e) . (a) The document filed contains SSN (as authorized by the order specified below). (b) The document filed contains confidential personal information as defined under 22 NYCRR 206.5(e) (as authorized by the order specified below). This document was previously filed REDACTED. Date: This document was previously filed UN-REDACTED. Date: The document filed seeks a remedy under 22 NYCRR 206.5(e)(2). The document filed seeks a remedy under 22 NYCRR 206.5(e)(3). Additional information: There is a previously filed order of the Court regarding this document: yes / no Date of order: Date order filed: Other identifying information for such order: The order of the Court is being filed with the redacted / un-redacted document: Date of order: Other identifying information for such order: yes / no Signature of filer:_________________________________________ Print Name: _________________________________________ Counsel appearing for: ____________________________________(name of party) Filer is Unrepresented / Pro se: Date:_______________ yes / no American LegalNet, Inc. www.FormsWorkFlow.com