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The statement shall be prefixed to the papers constituting the record on appeal. Statement Pursuant To CPLR Rule 5531 Form.This is a New York form and can be use in Appellate Division Appellate Courts. There has been no change in the parties. Minimize the risk of using outdated forms and eliminate rejected fillings. The statement pursuant to CPLR 5531. The general rule of practice is if you include one memorandum, then all memoranda should be included. STATEMENT PURSUANT TO CPLR § 5531. 1. The action is identified as Index Number 90-2018 in the Supreme Court,. The Indictment number is 2004-506. 2.