FORM 1: Sample Order to Show Cause
PRESENT: HON.
Justice
(name ofjudge, leave blank, clerk willfill in),
COURT OF THE STATE OF NEW YORK
'iF (county where you are filing case)
~~;

\.:

------------~

In the

~

-----------------------------------------------

Matte' of the Application of

(your name)

For a Judgment
ofthe Civil Pracf'

ORDER TO SHOW
CAUSE

to Article 78
dRules

RJI #:
Index No.

-against-

(names and titles ofRespon en s, e people you
are filing the case against)
Respondent(s).

Upon the annexed Petition of (your name), verified on the r-date

YOU

signed

"'li",

Verification) day of (month),

(year)~

and the annex

Show Cause and (list any other papers you are

Affidavit in Support of Order to

rrrt1ting with this Order), all the

proceedings held in regard to this matter, it is
ORDERED that

eave a. blank line here

assigned) be and hereby is assigned to Petitioner as the attorney whose duty it shall be
to conduct said proceeding free of charge to Petitioner, and it is further

SAMPLE FORM ONLY: Recopy or retype for your own case.
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405.12 Filing lUl Article 78 Pro Se
KMurtagh-Monks 03/08

ORDERED that service of a copy of this Order to Show Cause, together with a
copy of the papers upon which it was granted, by regular first class mail, upon the
Respondents (name ofRespondents), and upon the Attorney General of the State of
New Y9,[K"'OP or before the (leave blanks here, judge will fill in information about
\~~~~~~;.

date)

\, -');' day of

will be deemed sufficient service, and it is

...

':.'.~,.~~;:..>.';'::":"

further

t~f~~:

;,

ORDERED ,1h.a.;

e Clerk of the Court shall cause such service by regular mail

ff

v~l~~.

to be made upon the Respondents and Attorney General of the State of New York,
.

-

":~"1

LET the Respondentt~
Y.i

of the State of New Yor:W~~-c

J~'fJ"f;"t.

. Ifffuse before a Special Term ofthe Supreme Court
lIt<

'~'of (name of county you are filing in), at the

Courthouse thereof, on the (leave '1itC"'" -,
\--

here, judge will fill in) day of

!~l

i~

_ _ _ _ _ _ _ _, at _ _ o'er k in the forenoon of that day or as soon
{;:~.

thereafter as counsel can be heard why an Order and Judgment should not be made
'.W

pursuant to Article 78 of the CPLR granting

pet~

ner the relief requested in the

J

verified Petition annexed hereto.
ri'':'-;'~;':',,{l,"~~

ENTER:

l:~J

mSTICE OF THE SUPREME COURT
DATED:

SAMPLE FORM ONLY: Recopy or retype for your own case.
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405.12 Filing an Article 78 Pro Se
KMurtagh-Monks 03/08

FORM 2: Sample Mfidavit in Support of Order to Show Cause
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF (county where case is beingfiled)

In the Matter ofthe Application of
(youl!lfttn~e)

AFFIDAVIT IN SUPPORT OF
.ORDER TO SHOW CAUSE

Petitioner,
For a Judgment Pursuant to Article 78
of the Civil Practice" w and Rilles,
'"

RJI#:
Index No.

(names and titles ofRe.
.
Responden. '.
---------------------------------~

~

STATE OF NEW YORK ~
COUNTY OF (county where you are located)
,

!

h

(your name) , upon being dilly sw~jn, deposes and says:
,",'i~

1. I am the Petitioner in this proceeding.
2. I make this affidavit in support of my Pe
Civil Practice Law and Rules that this C

~

on pursuant to Article 78 of the

I
!

J

verse and vacate the

--determinationmade by Respondents on: (here you must put in the date of

the administrative decision you disagree with)

tha~

spell out what the decision was that you are chall~
,

~ and that this
-~"

Court direct Respondent(s) to: (write out what it is YOil are asking the

court to do

if it decides your petition has merit).

SAMPLE FORM ONLY: Recopy or retype for your own case.
3. (Explain in detail why you are using an Order to Show Cause rather than
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405.12 Filing an Article 78 Pro Se
KMurtagh-Monks 03/08

a Notice ofPetition. The reason will probably be that you are incarcerated
and cannot arrange to have a Notice ofPetition and Petition personally
delivered to the Respondent. )
4. Petitioner'designates (name ofcounty where case isfiled) County as place
;;('of~the
:,;.

;'.;.

special proceeding. The basis of venue is that (fill in reason you are

," '._~,g in this county, the reason usually is that the hearing, or Respondents'
\);:':'1>_

~il

'aecision or refusal to act took place in this county).

5. No previo . application for the same or similar relief herein prayed for has

been maq';,d''E';' ,

,,It,

tition~J;)",respectfully asks for an Order directing the
A~fM
Caus ~:;?'tfyhatever it is that you are asking the court to do

WHEREFORE".,
Respondent to Show

II

t~1

for you and requesting thelJou. td;~rder) should not be granted, and why such other
and further relief as may be just and prqer
,
'(

(You sign this infront ofa Notary;
Then print your name below the line.)

<iT

(leave this section blank, notary public will fill in .qlJ./~..information)
.',;;'-;,~~b~,~i.l".:",v·

Sworn to before me this
of

day

, _ _.

NOTARY PUBLIC

SAMPLE FORM ONLY: Recopy or retype for your own case.

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405.12 Filing an Article 78 Pro Se

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