Fill and Sign the Plaintiffdefendant Resides at Form

11 SUPREME COURT OF THE STATE OF NEW YORKIndex No.: 2 32 3 COUNTY OF Date Summons filed: 44 --------------------------------------------------------------------X Plaintiff designates 55 County as the place of trial The basis of venue is : 66 ________________________ Plaintiff, -against- SUMMONS WITH NOTICE Plaintiff/Defendant resides at : 77 ________________________ 88 ________________________ Defendant. ________________________ --------------------------------------------------------------------X ACTION FOR A DIVORCE To the above named Defendant: 99 YOU ARE HEREBY SUMMONED to serve a notice of appearance on the  Plaintiff OR  Plaintiff’s Attorney(s) within twenty (20) days after the service of this summons, exclusive of the day of service (or within thirty (30) days after the service is complete if this summons is not personally delivered to you within the State of New York); and in case of your failure to appe ar, judgment will be taken against you by default for the relief demanded in the notice set forth below. 10, 1110, 11 Dated ________________ Plaintiff  Attorney(s) for Plaintiff 1212 Phone No.: Address: 1313 NOTICE: The nature of this action is to dissolve the marriage between the parties, on the grounds: **DRL §170 subd.____ - __________________________________ The relief sought is a judgment of absolute divorce in favor of the Plaintiff dissolving the marriage between the parties in this action. 1414 The nature of any ancillary or additional relief requested (see p.14 of Instructions) is: _______________________________________________________________________________ Additional page describing ancillary relief requested is attached ;  Marital property to be distributed pursuant to separation agreement/stipulation;  I waive distribution of Marital property; For divorces commenced on or after 1/25/16 only : I am not seeking maintenance as payee as described in the Notice of Guideline Maintenance (the “Notice”) other than what was already agreed to in a written agreement/stipulation ; OR  I seek maintenance as payee, as described in the Notice  NONE - I am not requesting any ancillary relief; AND any other relief the court deems fit and proper ** Read pp. 3-5 of Instructions and insert the grounds for the divorce: DRL §170(1) - cruel and inhuman treatment DRL §170(4) - adultery DRL §170(2) - abandonment DRL §170(5) - living apart one year after separation decree or judgment of separation DRL §170(3) - confinement in prison DRL §170(6) - living apart one year after execution of a separation agreement DRL §170(7) - irretrievable breakdown in relationship (UD-1 Rev. 1/25/16)