22 CRR-NY D III E Form UCS-840NY-CRR
22 CRR-NY D III E Form UCS-840
22 CRR-NY D III E Form UCS-840
UCS-840 Request for judicial intervention
REQUEST FOR JUDICIAL INTERVENTION
UCS-840 (REV 1/2000)
| COURT, COUNTY INDEX NO. DATE PURCHASED: | For Clerk Only | ||
| _______________________ | |||
| PLAINTIFF(S): | |||
| IAS entry date | |||
| DEFENDANT(S): | |||
| Judge Assigned | |||
| RJI Date | |||
Date issue joined:
Bill of particulars served (Y/N): [ ] YES [ ] NO
| NATURE OF JUDICIAL INTERVENTION (check ONE box only AND enter information) | |
| [ ] Request for preliminary conference | [ ] Notice of petition (return date: ) |
| Relief sought | |
| [ ] Note of issue and/or certificate of readiness | [ ] Notice of medical or dental malpractice action (specify: ) |
| [ ] Notice of motion (return date: ) Relief sought | [ ] Statement of net worth |
| [ ] Order to show cause (clerk enter return date: ) Relief sought | [ ] Writ of habeas corpus |
| [ ] Other ex parte application (specify: ) | [ ] Other (specify: ) |
| NATURE OF ACTION OR PROCEEDING (Check ONE box only) | |||
| MATRIMONIAL | Malpractice | ||
| [ ] Contested | -CM | [ ] Medical/Podiatric | -MM |
| [ ] Uncontested | -UM | [ ] Dental | -DM |
| -OPM | [ ] *Other Professional | ||
| COMMERCIAL | _________________ | ||
| [ ] Contract | -CONT | [ ] Motor Vehicle | -MV |
| [ ] Corporate | -CORP | [ ] Products Liability | -PL |
| [ ] Insurance (where insurer is a | _________________ | ||
| party, except arbitration) | -INS | [ ] Environmental | -EN |
| [ ] UCC (including sales, negotiable | -UCC | [ ] Asbestos | -ASB |
| instruments) | [ ] Breast Implant | ||
| [ ] *Other Commercial | -OC | [ ] *Other Negligence | -OTN |
| ____________________ | ____________________ | ||
| [ ] *Other Tort (including | |||
| -OT | intentional) | ||
| REAL PROPERTY | ____________________ | ||
| [ ] Tax Certiorari | -TAX | ||
| [ ] Foreclosure | -FOR | SPECIAL PROCEEDINGS | |
| [ ] Condemnation | -COND | [ ] Art. 75 (Arbitration) | -ART75 |
| [ ] Landlord/Tenant | -LT | [ ] Art. 77 (Trusts) | -ART77 |
| [ ] *Other Real Property | -ORP | [ ] Art. 78 | -ART78 |
| _________________ | [ ] Election Law | -ELEC | |
| -GUARD81 | [ ] Guardianship (MHL Art. 81) | ||
| OTHER MATTERS | [ ] *Other Mental Hygiene | -MHYG | |
| [ ] *_______________ | -OTH | [ ] Other Special Proceeding | -OSP |
| TORTS | |||
Check “YES” or “NO” for each of the following questions:
Is this action/proceeding against a
| YES NO | YES NO | ||
| [ ] [ ] | Municipality: (Specify ) | [ ] [ ] | Public Authority: (Specify ) |
| YES NO | |
| [ ] [ ] | Does this action/proceeding seek equitable relief? |
| [ ] [ ] | Does this action/proceeding seek recovery for personal injury? |
| [ ] [ ] | Does this action/proceeding seek recovery for property damage? |
Pre-Note Time Frames:
(This applies to all cases except contested matrimonials and tax certiorari cases)
Estimated time period for case to be ready for trial (from filing of RJI to filing of Note of Issue):
□ Expedited: 0-8 months
□ Standard: 9-12 months
□ Complex: 13-15 months
Contested Matrimonial Cases Only: (Check and give date)
| Has summons been served? | □ No | □ Yes, Date |
| Was a notice of No Necessity filed? | □ No | □ Yes, Date |
ATTORNEY(S) FOR PLAINTIFF(S):
| Self Rep.* | Name | Address | Phone # |
|---|---|---|---|
| □ | |||
| □ |
ATTORNEY(S) FOR DEFENDANT(S):
| Self Rep.* | Name | Address | Phone # |
|---|---|---|---|
| □ | |||
| □ |
*Self Represented: parties representing themselves, without an attorney, should check the “Self Rep.” box and enter their name, address, and phone # in the space provided above for attorneys.
INSURANCE CARRIERS:
RELATED CASES: (IF NONE, write “NONE” below)
Title
Index #
Court
Nature of Relationship
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 OR PROCEEDING.
Dates:
______________ (SIGNATURE)
______________ (ATTORNEY FOR)
______________ (PRINT OR TYPE NAME)
ATTACH RIDER SHEET IF NECESSARY TO PROVIDE REQUIRED INFORMATION
22 CRR-NY D III E Form UCS-840
Current through May 31, 2021
| End of Document |
IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.