Fillable UCS 840 REQUEST FOR JUDICIAL INTERVENTION (NYS Unified Court System Division of Technology)

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UCS 840 REQUEST FOR JUDICIAL INTERVENTION (NYS Unified Court System Division of Technology)

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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:
COMMERCIALMATRIMONIAL
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
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 ZipCityStreet Address
NOYES
G
G
G
G
G
G
Supreme
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 CaseJudge (if assigned)CourtIndex/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 NameLast NameLast Name
G
Firm NameFirst Name
G NO
CityStreet Address
Primary Role:
e-mailFaxPhone
Secondary Role (if any):
G YES
First NameLast NameLast Name
G
Firm NameFirst Name
G NO
CityStreet Address
Primary Role:
e-mailFaxPhone
Secondary Role (if any):
G YES
First NameLast NameLast Name
G
Firm NameFirst Name
G NO
CityStreet Address
Primary Role:
e-mailFaxPhone
Secondary Role (if any):
G YES
First NameLast NameLast Name
G
Firm NameFirst Name
G NO
CityStreet Address
Primary Role:
e-mailFaxPhone
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
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G
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ZipState
ZipState
ZipState
ZipState
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UCS 840 REQUEST FOR JUDICIAL INTERVENTION (NYS Unified Court System Division of Technology)

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Completed 5 August 2020

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