STATE OF NEW YORK : COUNTY OF ___________________

CITY COURT of ________________________

____________________________________________
 

_______________________________________
 

                                                                                       NOTICE OF APPEAL
                                                          Plaintiff,
                  vs.
                                                                                        City Court Docket No. ___________
                                                          Defendant                             County Clerk Index No. __________
_________________________________                             (if known)

____________________________________________
 

PLEASE TAKE NOTICE THAT THE ABOVE NAMED _______________________________
                                                                                                                    (Appellant)
 

HEREBY APPEALS TO THE _____________________ COUNTY COURT FROM THE
                                                                   (name of county)
 

        _______DECISION/ORDER or

        _______JUDGMENT
 

OF THE SMALL CLAIMS / COMMERCIAL CLAIMS PART OF THE _______________ CITY COURT ENTERED IN THE OFFICE OF THE CLERK OF SAID COURT ON THE ________ DAY OF _____________________________ IN THE AMOUNT OF $________________ ;
 

AND FROM EVERY PART THEREOF.
 

DATED: _________________________                             ____________________________________
                                                                                                                Signature of Appellant

                                                                                        __________________________________
                                                                                                                Address of Appellant

                                                                                        ____________________________________

                                                                                        ____________________________________

TO:    1. ________________________________
                 Name of Opposing Party

             __________________________________
                Address of Opposing Party
             __________________________________
 

          2. ________________________________
                 Name of Attorney for Opposing Party (if any)

              __________________________________
                 Address of Attorney
              __________________________________
 

          3. _____________________ County Clerk
                  (name of county)