COMPLETE THIS SECTION FOR A COMMERCIAL FORM

*CERTIFICATION: (NYCCCA 1803-A)

I hereby certify that no more than (5) actions or proceedings (including the instant action or
proceeding) pursuant to the commercial claims procedure have been initiated in the courts of this
State during the present calendar month.

___________________________________
Signature of Claimant

____________________________________
Signature of Notary / Clerk / Judge

*NOTE: The Commercial Claims Part will dismiss any case where this certification is not made.

†CERTIFICATION: (NYCCA 1803-A)

I hereby certify that I have mailed a demand letter by ordinary first class mail to the party com-
plained against, no less than ten (10) days and no more than one-hundred eighty (180) days before I commenced this claim.

I hereby certify, based upon information and belief, that no more than five (five) actions or pro-
ceedings (including the instant action or proceeding) pursuant to the commercial claims procedure
have been initiated in the courts of this State during the present calendar month.

___________________________________
Signature of Claimant

____________________________________
Signature of Notary / Clerk / Judge

†NOTE: The Commercial Claims Part will not allow your action to
proceed if this certification is not made and properly completed.