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REQUEST FOR JUDICIAL INTERVENTION

For Court Clerk Use Only: REQUEST FOR JUDICIAL INTERVENTIONIAS Entry Date(7/2012)UCS-840 COUNTY OF_____COURT,Judge AssignedDate Index Issued:_____/_____/_____Index No: _____RJI Dateattach a caption rider the complete case caption. Do not use et al or et ano. If more space is required,CAPTION:Plaintiff(s)/Petitioner (s)-against-Defendant(s)/Respondent(s)Ch eck ONE box only and specify where OF ACTION OR PROCEEDING:COMMERCIALMATRIMONIALG Business Entity (including corporations, partnerships, LLCs, etc.)G ContestedG ContractNOTE: For all Matrimonial actions where the parties have children underG Insurance (where insurer is a party, except arbitration)the age of 18, complete and attach the MATRIMONIAL RJI UCC (including sales, negotiable instruments)For Uncontested Matrimonial actions, use RJI form Other Commercial:_____TORTS(specify)G AsbestosNOTE: For Commercial Division assignment requests [22 NYCRR 'G Breast (d)], complete and attach the COMMERCIAL DIV RJI Environmental: _____REAL PROPERTY: How many properties does the application include?

NATURE OF JUDICIAL INTERVENTION: Check ONE box only AND enter additio If yes, judgment date: _____ nal information where indi _/_____/___ cated. _____ Infant's Compromise Note of Issue and/or Certificate of Readiness

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