C. v. New York State and Local Retir

Filing 16

ACKNOWLEDGMENT AND NOTICE OF APPEARANCE, on behalf of Appellant Mary Jo C., FILED. Service date 06/20/2011 by CM/ECF.[319815] [11-2215]

ACKNOWLEDGMENT AND NOTICE OF APPEARANCE
Short Title: maw Jo C. v. New York State and Local Retirement System

Docket No.:

11-2215

Lead Counsel of Record (name/firm) or Pro se Party (name): wllliam M. Brooks, Mental Disability Law Clinic, Touro Law Center
Appearance for (party/designation): Plaintiff-AppeHant
DOCKET SHEET ACKNOWLEDGMENT/AMENDMENTS
Caption as indicated is:
( ) Correct
( J ) Incorrect. See attached caption page with corrections.
Appellate Designation is:
( ) Correct
( ) Incorrect. The following parties do not wish to participate in this appeal:
Parties:
( ) Incorrect. Please change the following parties' designations:

Partv

Correct Designation

Contact Information for Lead Counsel/Pro Se Party is:
( J ) Correct
( ) Incorrect or Incomplete, and should be amended as follows:
Name:
Firm:
Address:
Telephone:
Ematl:

Fax:

RELATED CASES
( J ) This case has not been before this Court previously.
(

) This case has been before this Court previously. The short title, docket number, and citation are:

) Matters related to this appeal or involving the same issue have been or presently are before this Court. The short titles,
docket numbers, and citations are:
(

CERTIFICATION
I certify that (
October 28,2009

) I am admitted to practice in this Court and, if required by LR 46.1(a)(2), have renewed my admission o n
O R that ( ) I applied for admission o n
or renewal on

. If the Court has not yet admitted me or approved my renewal, I have completed Addendum A.
Signature of Lead Counsel of Record:
Type or Print Name:

f%&

P

Signature of pro se litigant:
Type or Print Name:
( ) I am a pro se litigant who is not an attorney.
( ) I am an incarcerated Dro se litigant.

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