CIVIL COURT OF THE CITY OF NEW YORK
APPLICATION FOR SUMMONS
PARTIES
PLAINTIFF: Please print your name, complete address, including your apartment number (no P.O. box
number) and telephone number. [Please note: If the claim is based on an auto accident, the claim must be
Owner against Owner]. A Corporation must be represented by an attorney
DEFENDANT(S): Please print the full legal name and street address (no P.O. box number) of
the parties you are suing. Indicate whether you are suing this party as a person or a business.
[Please 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 cause to: automobile person property other than automobile
Failure to provide: repairs proper service goods ordered
Failure to return: security property deposit money
Failure to pay for: wages services rendered insurance claim money loaned
Rent commissions goods sold and delivered
Breach of: contract lease
Loss of: luggage property time from work use of property
Name: ILAN ELISHAYEV
Address: 110-12 68th Road, Forest Hills, NY 11375
New York City Parks Department
The Arsenal, Central Park, 830 Fifth Avenue, New York, NY 10065
or
110-12 68 ROAD, QUEENS (FOREST HILLS)
New York, 11375
Returned: check (bounced) merchandise (not reimbursed)
Other: (Be brief)
DETAILS OF CLAIM: Amount of Claim: (Limit $50,000 for each Cause of Action)
Date of Occurrence:
Place of Occurrence:
If Car Accident: YOUR license plate N/A DEFENDANT’S license plate: N/A
Identifying Number(s): SR Number 311-09795793
(Receipt #, Claim #, Account #, Policy #, Ticket #, etc.)
Date Signature of Plaintiff
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