APPLICATION FOR INDEX NUMBER
PURSUANT TO SECTION 8018 C.P.L.R.
Fee: $170.00

SPACES BELOW TO BE TYPED OR
PRINTED BY APPLICANT

TITLE OF ACTION OR PROCEEDING

SUPREME/COUNTY COURT, FRANKLIN COUNTY

  --------------------------------------

  VS.

  --------------------------------------

-----------------------------------------------------------------
NAME AND ADDRESS OF ATTORNEY
FOR PLAINTIFF OR PETITIONER

-----------------------------------------------------------------
NAME AND ADDRESS OF ATTORNEY
FOR DEFENDANT OR RESPONDENT

-----------------------------------------------------------------
DO NOT DETACH
-----------------------------------------------------------------
  TITLE OF ACTION OR PROCEEDING TO BE TYPED
  OR PRINTED BY APPLICANT
SUPREME/COUNTY COURT, ESSEX COUNTY

COMPLETE THIS STUB ______________________________
  INDEX #___________________
  FEE: $ 170.00
  VS. ENDORSE THIS INDEX
  NUMBER ON ALL PAPERS
  AND ADVISE YOUR
  ______________________________ ADVERSARY OF ASSIGNED NUMBER

INDEX APPLICATION FILED BY _______________________________________________