eLaws | eCases | State of New York |
 New York Codes Rules Regulations (Last Updated: March 27,2024)
 TITLE 22. Judiciary
 Subtitle D. Forms
 Chapter III. Supreme and County Court Forms
 Subchapter E. Miscellaneous Supreme and County Court Forms
  UCS-840 Request for judicial intervention

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-FORSPECIAL 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.*NameAddressPhone #
□
□
ATTORNEY(S) FOR DEFENDANT(S):
Self Rep.*NameAddressPhone #
□
□
*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