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NEW YORK STATE COURT OF APPEALS Preliminary Appeal (NYS Unified Court System Division of Technology)

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NEW YORK STATE
COURT OF APPEALS
Preliminary Appeal Statement
Pursuant to section 500.9 of the Rules of the Court of Appeals
1. CAPTION OF CASE (as the parties should be denominated in the Court of Appeals):
STATE OF NEW YORK COURT OF APPEALS
-against-
______________________________________________________
2. Name of court or tribunal where case originated, including county, if applicable:
____________________________________________________________________
3. Civil index number, criminal indictment number or other number assigned to the matter in the
court or tribunal of original instance:____________________
4. Docket number assigned to the matter at the Appellate Division or other intermediate
appellate court:_____________________
5. Jurisdictional basis for this appeal:
____Leave to appeal granted by the Court of Appeals or a Judge of the Court of Appeals
____Leave to appeal granted by the Appellate Division or a Justice of the Appellate
Division
____CPLR 5601(a): dissents on the law at the Appellate Division
____CPLR 5601(b)(1): constitutional ground (Appellate Division order)
____CPLR 5601(b)(2): constitutional ground (judgment of court of original instance)
____CPLR 5601(c): Appellate Division order granting a new trial or hearing, upon
stipulation for judgment absolute
____CPLR 5601(d): from a final judgment, order, determination or award, seeking
review of a prior nonfinal Appellate Division order
____Other (specify)_____________________________________________________
6. How this appeal was taken to the Court of Appeals (choose one) (see CPLR 5515[1]):
[ Attach additional
sheets if further
space is required ]
NOTICE OF APPEAL Date filed:________________________
Clerk's office where filed:_________________
ORDER GRANTING LEAVE TO APPEAL (civil case):
Court that issued order:______________
Date of order:_________________
CERTIFICATE OR ORDER GRANTING LEAVE TO APPEAL (criminal case):
Justice or Judge who issued order:_______________
Court:________________
Date of order:__________________
7. Demonstration of timeliness of appeal in civil case (CPLR 5513, 5514):
Was appellant served by its adversary with a copy of the order, judgment or
determination appealed from and notice of its entry? ___yes ___no
If yes, date on which appellant was served (if known, or discernable from the
papers served): __________________
If yes, method by which appellant was served: ____personal delivery
____regular mail
____overnight courier
____other (describe___________)
Did the Appellate Division grant or deny a motion for leave to appeal to this
Court in this case? ____yes ____no
If yes, fill in the following information:
a. date appellant served the motion for leave to appeal made
at the Appellate Division: ________________
b. date on which appellant was served with the Appellate
Division order granting or denying such motion with notice
of the order's entry: ________________________ , and
c. method by which appellant was served with the Appellate Division order
granting or denying such motion:
_________________ personal service
_________________ regular mail
_________________ overnight courier
_________________ other (describe __________)
2
8. Party Information:
Instructions: Fill in the name of each party to the action or proceeding, one name per line. Indicate the status of the party
in the court of original instance and the party's status in this Court, if any. Examples of a party’s original status include:
plaintiff, defendant, petitioner, respondent, claimant, third-party plaintiff, third-party defendant, intervenor
. Examples of
a party’s Court of Appeals status include: appellant, respondent, appellant-respondent, respondent-appellant, intervenor-
appellant.
No. Party Name Original Status Court of Appeals Status
1
2
3
4
5
6
7
8
9
10
9. Attorney information:
Instructions: For each party listed above, fill in the name of the one law firm and responsible attorney who will act as
counsel of record, if the party is represented. Where a litigant is self-represented, fill in that party’s data in section 10
below.
For Party No. __ above:
Law Firm Name:___________________________________________________________________________________
Responsible Attorney:_______________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:________________________State:__________Zip:___________________________________________________
Telephone No:______________Ext._________________Fax:_______________________________________________
If appearing Pro Hac Vice, has attorney satisfied requirements of section 500.4 of the Rules of the Court of
Appeals?___yes ____no
For Party No. __ above:
Law Firm Name: ___________________________________________________________________________________
Responsible Attorney:_______________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:________________________State:__________Zip:___________________________________________________
Telephone No:______________Ext._________________Fax:_______________________________________________
If appearing Pro Hac Vice, has attorney satisfied requirements of section 500.4 of the Rules of the Court of
Appeals?___yes ____no
For Party No. __ above:
Law Firm Name:___________________________________________________________________________________
Responsible Attorney:_______________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:________________________State:__________Zip:___________________________________________________
Telephone No:______________Ext._________________Fax:_______________________________________________
If appearing Pro Hac Vice, has attorney satisfied requirements of section 500.4 of the Rules of the Court of
Appeals?___yes ____no
3
For Party No. __ above:
Law Firm Name:___________________________________________________________________________________
Responsible Attorney:_______________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:________________________State:__________Zip:___________________________________________________
Telephone No:______________Ext._________________Fax:_______________________________________________
If appearing Pro Hac Vice, has attorney satisfied requirements of section 500.4 of the Rules of the Court of
Appeals?___yes ____no
For Party No. __ above:
Law Firm Name:___________________________________________________________________________________
Responsible Attorney:_______________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:________________________State:__________Zip:___________________________________________________
Telephone No:______________Ext._________________Fax:_______________________________________________
If appearing Pro Hac Vice, has attorney satisfied requirements of section 500.4 of the Rules of the Court of
Appeals?___yes ____no
(Use additional sheets if necessary)
10. Self-Represented Litigant information:
For Party No. ___ above:
Party’s Name:______________________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:_____________________State:____________Zip:____________________________________________________
Telephone No.:_________________Ext.____________Fax:_________________________________________________
For Party No.___above:
Party’s Name:______________________________________________________________________________________
Street Address:_____________________________________________________________________________________
City:_____________________State:____________Zip:____________________________________________________
Telephone No.:_________________Ext.____________Fax:_________________________________________________
11. Related motions and applications:
Does any party to the appeal have any motions or applications related to this appeal
pending in the Court of Appeals? ___yes ___no
If yes, specify:
a. the party who filed the motion or application:___________________________
b. the return date of the motion: _______________________________________
c. the relief sought: _________________________________________________
Does any party to the appeal have any motions or applications in this case currently
pending in the court from which the appeal is taken? ____yes ____no
4
If yes, specify:
a. the party who filed the motion or application:___________________________
b. the return date of the motion: _______________________________________
c. the relief sought:_________________________________________________
Are there any other pending motions or ongoing proceedings in this case? If yes, please
describe briefly the nature and the status of such motions or proceedings:_____________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
12. Set forth, in point-heading form, issues proposed to be raised on appeal (this is a
nonbinding designation, for preliminary issue identification purposes only):
(use additional sheet, if necessary)
13. Does appellant request that this appeal be considered for resolution pursuant to section
500.11 of the Rules of the Court of Appeals (Alternative Procedure for Selected
Appeals)?
_____yes ____no
If yes, set forth a concise statement why appellant believes that consideration pursuant
to section 500.11 is appropriate (see section 500.11[b]):___________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
14. Notice to the Attorney General.
Is any party to the appeal asserting that a statute is unconstitutional? ____yes _____no
If yes, has appellant met the requirement of notice to the Attorney General in section
500.9(b) of the Rules of the Court of Appeals? ____yes ____no
5
(Fill in on lines below)
15. ITEMS REQUIRED TO BE ATTACHED TO EACH COPY OF THIS
STATEMENT:
A. A copy of the filed notice of appeal to the Court of Appeals (with proof of
service), a copy of the order granting leave to appeal to the Court of Appeals (civil
case), or a copy of the certificate granting leave to appeal to the Court of Appeals
(criminal case), whichever is applicable;
B. A copy of the signed order, judgment or determination appealed from to this
Court (use document issued by the court, not internet version);
C. A signed copy of any order, judgment or determination which is the subject of
the order appealed from, or which is otherwise brought up for review (use
document issued by the court, not internet version);
D. Copies of all decisions or opinions relating to the orders set forth in subsections
B and C above (use documents issued by the court, not internet versions); and
E. If required, a copy of the notice sent to the Attorney General pursuant to section
500.9(b) of the Rules of the Court of Appeals.
F. If required, a disclosure statement pursuant to section 500.1(f) of the Rules of the
Court of Appeals.
Date:_________________ Submitted by: ____________________________________
(Name of law firm)
____________________________________
(Signature of responsible attorney)
____________________________________
(Typed name of responsible attorney)
Attorneys for appellant _____________________________
(Name of party)
-or-
Date:_________________ Submitted by____________________________, pro se
(
Signature of appellant)
__________________________________________
(
Typed/printed name of self-represented appellant)
EFFECTIVE 12/08/10
6
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NEW YORK STATE COURT OF APPEALS Preliminary Appeal (NYS Unified Court System Division of Technology)

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Completed 5 March 2022

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