STATEMENT PURSUANT TO CPLR RULE 5531 1. 2. The Docket Number in the Court below is: ______________ The full names of the original parties were: In the Matter of ___________________________________ -Petitioner v _____________________________ - Respondents. This appeal is on behalf of ________________. 3. 4. 5. 6. The action was commenced in the Family Court, County of __________________. The action was commenced by the filing of a Petition in the Office of the Clerk of the Family Court on ________________. This action is against ________________ and is a petition pursuant to____________ to ________________. This is an appeal by the law guardian representing _________/respondent from an order of the ____________ County Family Court, (_____, J.) entered ______________________. The appendix method is not being used herein. This appeal is on the original record [pursuant to an Order of this Court dated ____________, and filed and entered on ______________________]. 7. 8. 2002 © American LegalNet, Inc.