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UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT Thurgood Marshall U.S. Courthouse at Foley Square 40 Centre Street, New York, NY 10007 Telephone: 212-857-8500
MOTION INFORMATION STATEMENT Caption [use short title] Docket N umber(s):

M otion for:

Set forth belo w precise, co mple te statement of relief sough t:

M OV ING P AR TY: 9 Plaintiff 9 Appellant/Petitioner


9 Defendant 9 Appellee/Respondent
OPPOSING ATTORNEY [Name]: [name of attorney, with firm , address, phone numb er and e-mail]

M OV ING A TTO RN EY: [name of attorney, with firm , address, phone numb er and e-mail]

Court-Jud ge/Agency appealed from: Please check appropriate boxes: Has consent of opposing counsel: A. been sought? B. been obtained? FOR EMERGENCY MOTIONS, MOTIONS FOR STAYS AND INJUNCTIONS PENDING APPEAL: Has request for relief been made below? 9 Yes 9 No

9 Yes 9 Yes

9 9

No No No

Has this relief been previously sought in this Co urt?



9 No

Is oral argum ent requested? 9 Yes 9 (requests for oral argument will not necessarily be granted)

Req uested return d ate and explanation of emergency: _______________________________________________________ _______________________________________________________

Has argume nt date of appeal been set? 9 Yes 9 No If yes, enter date __________________________________________

Signature of Moving Attorney: _______________________________

Date: ___________________

Has service been effected? [Attach proof of service]



9 No

ORDER IT IS HEREBY ORDERED THAT the motion is GRANTED DENIED. FOR THE COURT: CATHERINE O'HAGAN WOLFE, Clerk of Court Date: _____________________________________________ By: _______________________________________

Form T-1080 (Revised 10/31/02).