REQUEST FOR JUDICIAL INTERVENTION Settlement Conference in Residential Mortgage Foreclosure Actions _______________________________ Court, ____________________ County Index No. ____________________ Date Index No. Issued __________________ ___________________________________________________________________________ For Clerk Only PLAINTIFF(S): _____________ IAS entry date _____________ Judge Assigned DEFENDANT(S): _____________ RJI Date ___________________________________________________________________________ This form requests the scheduling of the settlement conference required by Rule 3408 of the Civil Practice Law and Rules in a mortgage foreclosure action involving all of the following: � residential mortgage entered into between January 1, 2003, and September 1, 2008 � one to four-family owner-occupied dwelling � subprime, high-cost or nontraditional loan as defined in section 6-l of the Banking Law and section 1304.5(c) and (e) of the Real Property Actions and Proceedings Law Provide the following information Property Address: Defendant(s) [name, address, telephone number, e-mail address]: Attorney for Plaintiff(s) [name, address, telephone number, e-mail address]: (if self-represented, provide the information for yourself) Attorney for Defendant(s) (if known) [name, address, telephone number, e-mail address]: 90-day notice [RPAPL §1304(1)] mailed on [date]: Related cases [title, index no. court, judge (if assigned), relationship to instant case]: I AFFIRM UNDER PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION PREVIOUSLY BEEN FILED IN THIS ACTION. Dated: _____________________________________________ SIGNATURE _____________________________________________ PRINT OR TYPE NAME Address and telephone number (if different from above): American LegalNet, Inc. www.FormsWorkFlow.com