Fill and Sign the Rji Form Fill Online Printable Fillable Blankpdffiller

For Court Clerk Use Only: REQUEST FOR JUDICIAL INTERVENTION IAS Entry Date (7/2012) UCS-840 COUNTY OF___________________________ ________________________COURT, Judge Assigned Date Index Issued:___________________ Index No: _____________________ RJI Date attach a caption rider sheet.Enter 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) Check ONE box only and specify where indicated. NATURE OF ACTION OR PROCEEDING: COMMERCIAL MATRIMONIAL G Business Entity (including corporations, partnerships, LLCs, etc.) G Contested G Contract NOTE: For all Matrimonial actions where the parties have children under G Insurance (where insurer is a party, except arbitration) the age of 18, complete and attach the MATRIMONIAL RJI Addendum. G UCC (including sales, negotiable instruments) For Uncontested Matrimonial actions, use RJI form UD-13. G O ther Commercial:_________________________________________________ TORTS (specify) G Asbestos NOTE: For Commercial Division assignment requests [22 NYCRR ' G Breast Implant 202.70(d)], complete and attach the COMMERCIAL DIV RJI Addendum. G Environmental: ________________________________________________ REAL PROPERTY: How many properties does the application include? _________ (specify) G Condemnation G Medical, Dental, or Podiatric Malpractice G Residential G Mortgage Foreclosure (specify): G Motor Vehicle Property Address: ____________________________________________________ G Products Liability:_______________________________________________ (specify) NOTE: For Mortgage Foreclosure actions involving a one- to four-family, G O ther Negligence:_______________________________________________ owner-occupied, residential property, or an owner-occupied (specify) condominium, complete and attach the FORECLOSURE RJI Addendum. G Other Professional Malpractice:____________________________________ G Tax Certiorari - Section: __________ Block: __________ Lot: __________ (specify) G Tax Foreclosure G O ther Tort:_____________________________________________________ G O ther Real Property:________________________________________________ (specify) (specify) OTHER MATTERS SPECIAL PROCEEDINGS G Certificate of Incorporation/Dissolution [see NOTE under Commercial] G CPLR Article 75 (Arbitration) [see NOTE under Commercial] G Emergency Medical Treatment G CPLR Article 78 (Body or Officer) G Habeas Corpus G Election Law G Local Court Appeal G MHL Article 9.60 (Kendra's Law) G Mechanic's Lien G MHL Article 10 ( Sex Offender Confinement-Initial ) G Name Change G MHL Article 10 (Sex Offender Confinement-Review ) G Pistol Permit Revocation Hearing G MHL Article 81 (Guardianship) G Sale or Finance of Religious/Not-for-Profit Property G O ther Mental Hygiene:______________________________________________ G Other:________________________________________________________ (specify) (specify) G O ther Special Proceeding:___________________________________________ (specify)(specify) Answer YES or NO for EVERY question AND enter additional information where indicated. STATUS OF ACTION OR PROCEEDING: If yes, date filed: _____________________________ Has a summons and complaint or summons w/notice been filed? If yes, date served: _____________________________ Has a summons and complaint or summons w/notice been served? If yes, judgment date: _____________________________ Is this action/proceeding being filed post-judgment? G Commercial State Zip City Street Address NO YES G G G G G G Supreme Albany Alab am a Check ONE box only AND enter additional information where indicated. NATURE OF JUDICIAL INTERVENTION:Infant's Compromise Note of Issue and/or Certificate of Readiness Date Issue Joined: _____________________________ Notice of Medical, Dental, or Podiatric Malpractice Return Date: _____________________________ Relief Sought: _________________________ Notice of Motion Return Date: _____________________________ Relief Sought: _________________________ Notice of Petition Return Date: _____________________________ Relief Sought: _________________________ Order to Show Cause Relief Sought: _________________________ Other Ex Parte Application Poor Person Application Request for Preliminary Conference Residential Mortgage Foreclosure Settlement Conference Writ of Habeas Corpus Other (specify): _________________________________________________________________________________________________________ List any related actions. For Matrimonial actions, include any related criminal and/or Family Court cases. RELATED CASES: If additional space is required, complete and attach the RJI Addendum. If none, leave blank. Relationship to Instant Case Judge (if assigned) Court Index/Case No. Case Title For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail address in space provided. PARTIES: If additional space is required, complete and attach the RJI Addendum. Carrier(s):Insurance (Y/N): Joined Issue Attorneys and/or Unrepresented Litigants : Parties: Rep Un- litigants, provide address, phone number and e-mail address. address of all attorneys that have appeared in the case. For unrepresented Provide attorney name, firm name, business address, phone number and e-mail 3rd-party plaintiff). indicate party role(s) (e.g. defendant; List parties in caption order and G YES First Name Last Name Last Name G Firm Name First Name G NO City Street Address Primary Role: e-mail Fax Phone Secondary Role (if any): G YES First Name Last Name Last Name G Firm Name First Name G NO City Street Address Primary Role: e-mail Fax Phone Secondary Role (if any): G YES First Name Last Name Last Name G Firm Name First Name G NO City Street Address Primary Role: e-mail Fax Phone Secondary Role (if any): G YES First Name Last Name Last Name G Firm Name First Name G NO City Street Address Primary Role: e-mail Fax Phone Secondary Role (if any): THIS ACTION OR PROCEEDING. BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION PREVIOUSLY BEEN FILED IN I AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE ________________________________________________ Dated: _____________________________ SIGNATURE ________________________________________________ ________________________________________________ PRINT OR TYPE NAME ATTORNEY REGISTRATION NUMBER G G G G G G G G G G G G Zip State Zip State Zip State Zip State Alt ern at e Service Alt ern at e Service Alt ern at e Service Alt ern at e Service Plain t iff Plain t iff Alab am a Plain t iff Plain t iff Alab am a Plain t iff Plain t iff Alab am a Plain t iff Plain t iff Alab am a Prin t Fo rm