Civil Court of the City of New York
County of Part Index Number
NOTICE OF APPEAL
Defendant(s)/Respondent(s) PLEASE TAKE NOTICE that the Appellant, hereby appeals to the Appellate Term of the Supreme Court, First/Second Department, from
the Order/Judgment by the Hon.
Judge of the Civil/Housing Court of the City of New York, entered in the office of the Clerk of
said Court on
, and from each and every part thereof.
Appellant's Signature: Appellant's Name:
CIV-GP-67A (Revised October, 2003)
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.