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I JC2600 AG5067 REV. 7/99 STATE OF NEW YORK - JUDICIARY APPELLATE DIVISION LAW GUARDIAN VOUCHER I Originating Agency - Appellate Division Supreme Court Payment Date DD MM OCS Use Only W Liability Date MM Additional Payee ID Zip Code Route Payee Amount MIR Date MM DD W Payee Name Limit to 30 spaces IRS Code IRS Amount Stat. 2 part 4 in the Famiiy/SupremdSurrogate e circle applicable forum Court of / County from to for docket /index /file number IN.

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