UNCONTESTED MATRIMONIAL REQUEST FOR JUDICIAL INTERVENTION For Court Clerk Use Only: UD-13 (rev. 5/2011) ________________________COURT, _________________________COUNTY Index No: _____________________ IAS Entry Date Date Index Issued:______/______/__________ CAPTION: Judge Assigned RJI Date Enter the complete case caption. Do not use et al or et ano. Plaintiff -against- Defendant STATUS OF ACTION OR PROCEEDING: Answer YES or NO, and provide additional information where indicated. YES G G G Has a summons been filed? Has a summons been served? Are there children of the marriage under the age of 18? NATURE OF JUDICIAL INTERVENTION: NO G G G If yes, date filed: ________/________/____________ If yes, date served: ________/________/____________ If yes, complete and attach the MATRIMONIAL RJI Addendum (UCS-840M). EX PARTE APPLICATION FOR THE DISSOLUTION OF MARRIAGE ADDITIONAL RELIEF: Check all that apply Poor Person Application G G G Application for Alternate Service Other (specify): _____________________________________________________________________________________________________________ PARTIES: For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail address in "Attorneys" space. Parties UnRep List party names. Attorneys Issue Joined (Y/N): Provide attorney name, firm name, business address, phone number and e-mail address. Name: G N/A Role: PLAINTIFF Name: G YES G NO G Role: DEFENDANT RELATED CASES: List any related cases, include any related criminal and/or Family Court cases. Case Title Index/Case No. Court Judge (if assigned) Relationship to Instant Case I AFFIRM UNDER THE 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 OR PROCEEDING. Dated: ________/________/____________ ________________________________________________ SIGNATURE ________________________________________________ ________________________________________________ ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME American LegalNet, Inc. www.FormsWorkFlow.com