Free Application for Pro Se Summons - New York

Instructions for Service of a Summons and Complaint Who can serve? A person over the age of 18, who is not a party to the action, may serve the summons. I. Personal delivery: A copy of the summons and complaint may be served by giving it to the defendant in his or her hand. The server must fill out an affidavit of service and return it to the court within 14 days of the service of the summons and complaint. Substituted delivery: A copy of the summons and complaint may be left with a person other than the defendant at the defendant's residence or place of business. A copy of the summons and complaint must be mailed to the defendant in an envelope marked ''Personal and Confidential within 20 days of the service on the substituted person.'' The envelope may not indicate that it is from an attorney or that it concerns an action against the defendant An affidavit of service must be filled out by the server indicating the date of service and the date of mailing. The affidavit must be filed with the court within 14 days of the date of the mailing of the summons and complaint. 3, Conspicuous delivery: If no one can be found to receive the summons and complaint after a diligent effort to serve the papers (at least three attempts), on the third attempt the summons and complaint may be served by conspicuous delivery. This is also known as ''Nail and Mail.'' This delivery requires that a copy of the summons and complaint be affixed to the door of the actual residence or place of business of the defendant, normally with adhesive tape. A copy of the summons and complaint must be mailed to the defendant in an envelope marked ''Personal and Confidential within 20 days of the affixing of the Summons and Complaint. '' The envelope may not indicate that it is from an attorney or that it concerns an action against the defendant

2.

Civil Court of the City of New York

Application for a Pro Se Summons PARTIES

Plaintiff: (YOUR name and complete address, including your apartment number and telephone number.) [NOTE: If the claim is based on an auto accident, the claim must be Owner against Owner].

Defendant(s): (The full legal name and street address (no box number) of the party(ies) you are suing. Indicate whether you are suing this party as a person or a business.) [NOTE: If you are suing a business, indicate whether it is a partnership, a corporation or an individual with a business certificate. This information can be obtained in the County Clerk's Office in the county in which the business is located. Failure to check this information may result in a Judgment which cannot be executed.]

CLAIM REASON FOR CLAIM: Damage caused to: Failure to provide: Failure to return: Failure to pay for: automobile repairs security wages rent contract luggage check (bounced) person proper services property services rendered commissions lease property merchandise (not reimbursed) time from work use of property property other than automobile goods ordered deposit money money loaned

insurance claim goods sold and delivered

Breach of-. Loss of-. Returned:

Other: (Be Brief)

DETAILS OF CLAIM: Amount of Claim: (Limit $25,000 for each Cause of Action) Date of Occurrence: Place of Occurrence: If Car Accident: YOUR license plate # Identifying Number(s): (Receipt #, Claim #, Account #, Policy #, Ticket #, etc.) DEFENDANT'S license plate #

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Today's Date CIV-GP-50 (12/03) Signature of Plaintiff
FREE CIVIL COURT FORM No fee may be charged to fill in this form. Form can be found at: http://www.nycourts.gov/courts/nyc/civil/forms.shtml.