Jury Demand in Barry Podber v. Almonte Mill Food Corp., Almonte Mill Food Corp.D/B/A Key Food Supermarket, Shoreview Gardens Company, Llc| Trellis.Law

On September 14, 2023 a DEMAND FOR: - COMBINED DEMANDS TO PLTF was filed involving a dispute between Barry Podber, and Almonte Mill Food Corp., Almonte Mill Food Corp.D B A Key Food Supermarket, Shoreview Gardens Company, Llc, for Torts - Other (Fall) in the District Court of Kings County.

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FILED: KINGS COUNTY CLERK 11/09/2023 05:57 PM INDEX NO. 526706/2023
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 11/09/2023

SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
---------------------------------------------------------------- X
BARRY PODBER
DEMAND FOR VERIFIED
Plaintiff, BILL OF PARTICULARS

-against- Index No. 526706/2023
ALMONTE MILL FOOD CORP., ALMONTE
HILL FOOD CORP. D/B/A KEY FOOD
SUPERMARKET, T.F. REALTY (M.B.) CORP.,
AND SHOREVIEW GARDENS COMPANY, LLC,

Defendants.
---------------------------------------------------------------- X

PLEASE TAKE NOTICE that, pursuant to Sections 3041, 3042, 3043 and 3044 of the

Civil Practice Law and Rules, plaintiff is hereby required to serve upon the undersigned within

thirty (30) days after the receipt of this Demand, a Verified Bill of Particulars stating the following:

1. Set forth plaintiff’s date of birth.

2. Set forth plaintiff Social Security Number.

3. Set forth plaintiff’s aliases or other names for which he has used or is known by.

4. Set forth plaintiff's place of residence.

5. The dates and times of the day of the alleged negligent acts and/or omissions which

plaintiff alleges against defendants.

6. The exact location of the alleged negligent acts and/or omissions charged against

defendants.

7. A statement of each and every act of negligence, commission or omission which

plaintiff claims to have caused plaintiff 's injuries.

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8. State the name of each and every person who performed each of the above acts or

failures to act; if the names are not known, describe their physical appearances with sufficient

clarity for ready identification and state the occupation of each person.

9. Whether actual or constructive notice is claimed.

10. If actual notice is claimed, when and to whom it was given.

11. Whether or not any claim is made as to improper or defective equipment or

property, and if so, identify the equipment or property and state the alleged defective conditions.

12. State:

(a) the injuries alleged to have been suffered by plaintiff due to the alleged
negligence of defendants.

(b) set forth which injuries are claimed to be permanent and in what respect
they are claimed to be permanent.

13. State the length of time plaintiff was confined to each of the following:

(a) bed;

(b) house; and

14. State separately and total amounts claimed by plaintiff as special damages for each

of the following:

(a) physicians' services with names and addresses of such physicians;

(b) nurses' services;

(d) hospital expenses, with the names and addresses of all hospitals;

(e) loss of earnings; and

(f) any other expenses claimed as an item of special damages.

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15. For each of the alleged special damages claimed by plaintiff, state whether

Medicare has paid for any of the medical services received or expenses incurred. For any medical

services or expenses paid by Medicare, state separately the dates of treatment; the type of service

provided; the amount of the payment or reimbursement from Medicare; and the date of payment

or reimbursement by Medicare.

16. State the:

(a) length of time plaintiff was unable to attend to his employment;

(b) name and address of plaintiff 's employer;

(c) amount of money plaintiff was alleged to have earned during the five (5)
years prior to the alleged injuries which form the basis of his complaint; and

(d) amount of earnings the plaintiff was alleged to have lost as a result of the
injuries alleged in the Complaint.

17. If plaintiff alleges that defendants violated a statute, regulation, ordinance, code

and/or industry standard, set forth the exact section(s) of the violated statute, regulation, ordinance,

code and/or industry standard.

PLEASE TAKE FURTHER NOTICE that, in the event of plaintiff’s failure to comply

with this Demand for a Verified Bill of Particulars within thirty (30) days, a motion will be made

for an Order precluding plaintiff from offering any evidence at the trial of the action with respect

to the foregoing Demands.

Dated: New York, New York
November 9, 2023

Yours, etc.,

LANDMAN CORSI BALLAINE & FORD P.C.

By: /s/ Joseph Capraro
Joseph Capraro
Attorneys for Defendants

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ALMONTE MILL FOOD CORP.,
ALMONTE MILL FOOD CORP. D/B/A KEY
FOOD SUPERMARKET, and T.F. REALTY
(M.B.) CORP.
120 Broadway 13th Floor
New York, New York 10271
(212) 238-4800

TO: Domenic M. Recchia, Esq.
DOMENIC M. RECCHIA JR. ESQ
Attorney for Plaintiff
172 Gravesend Neck Road
Brooklyn, New York 11223
(718) 336-5550

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SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
---------------------------------------------------------------- X
BARRY PODBER,
NOTICE OF DISCOVERY AND
Plaintiff, INSPECTION OF DOCUMENTS

-against- Index No. 526706/2023
ALMONTE MILL FOOD CORP., ALMONTE Judge:
MILL FOOD CORP. D/B/A KEY FOOD
SUPERMARKET, T.F. REALTY (M.B.) CORP.,
AND SHOREVIEW GARDENS COMPANY, LLC,

Defendants.
---------------------------------------------------------------- X

PLEASE TAKE NOTICE that, pursuant to Rules 3101 and 3120 of New York Civil

Practice Law and Rules, the undersigned demands that plaintiff produce and permit the

undersigned to inspect and copy on November 29, 2023, at 10 a.m. at the offices of Landman Corsi

Ballaine & Ford P.C., 120 Broadway, New York, New York 10271 the following documents:

INSTRUCTIONS

A. This notice is intended to cover all documents in possession of the plaintiff, his

agents and his representatives or which are subject to the custody and control of plaintiff, his

representatives or agents.

B. "Medical records" includes all records and reports of any treatment by a medical

doctor, osteopathic physician, podiatrist, chiropractic doctor, physical therapist or other person

who performs any form of healing art.

C. Where the term "incident" is used, it refers to the event or events which form the

basis of this lawsuit.

D. Concerning: The term "concerning" means relating to, referring to, describing,

evidencing or constituting.

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E. The following rules of construction apply to all discovery requests:

(i) All/Each: The terms "all" and "each" shall be construed as all and each.

(ii) And/Or: The connectives "and" and "or" shall be construed either

disjunctively or conjunctively as necessary to bring within the scope of the discovery

request all responses that might otherwise be construed to be outside of its scope.

(iii) Number: The use of the singular form of any word includes the plural and

vice versa.

F. If plaintiff is able to produce only a portion of the requested documents at the

specified time, defendants request that such production be made and that plaintiff provide

defendants in writing with the: (1) reasons for plaintiff’s failure to produce all the requested

documents, (2) a listing of documents or categories of documents which have not been produced,

and (3) the earliest date that plaintiff can complete the remaining production.

SCHEDULE

1. Copies of any and all statements -- narrative, recorded or transcribed -- of

employees of defendants and any memoranda prepared of interviews held with employees of

defendants.

2. Copies of all medical records concerning any treatment of plaintiff for injuries

allegedly suffered by him because of this incident.

3. Duly executed HIPAA compliant authorizations (with section 9a initialed) (sample

enclosed) permitting the undersigned to obtain and make copies of all ambulance, hospital and

medical records for those institutions and physicians that have treated the plaintiff.

4. Copies of plaintiff’s federal and state tax returns for the years 2019 through present.

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5. Duly executed and acknowledged written authorizations permitting the

undersigned to obtain and make copies of any and all tax returns of plaintiff for the years 2019

through present. (An authorization to be completed by plaintiff is attached hereto.)

6. A duly executed and acknowledged written authorization permitting the

undersigned to obtain and make copies of the plaintiff’s employment records from January 1, 2020

to present. (An authorization to be completed by plaintiff is attached hereto.)

7. Copies of all photographs and diagrams made and taken of the site of the incident

or of the equipment involved in the incident.

8. Name and address of any witness known to plaintiff or plaintiff’s attorney,

including witnesses to admissions, notice or conversation. Specify the name and address of any

witness to each of the following, including, but not limited thereto:

(a) the incident alleged in the Complaint;
(b) any acts, omissions or conditions which allegedly caused the incident
alleged in the Complaint;
(c) any actual notice allegedly given to defendants of any condition which
allegedly caused the incident alleged in the Complaint;
(d) the nature and duration of any alleged condition which allegedly caused the
incident alleged in the Complaint; and
(e) any statement or admission made by defendants or defendants’ agents,
servants or employees.

9. The names and addresses of all hospitals and physicians that treated plaintiff during

the five (5) years prior to the alleged injuries which form the basis of his complaint.

10. The names and addresses of all hospitals and physicians that treated plaintiff for

the alleged injuries which form the basis of his complaint.

11. If plaintiff claims as damages any past or future costs for medical or dental care,

custodial care of rehabilitation services, loss of earnings or other economic loss, provide:

(a) Documents evidencing insurance coverage in favor of plaintiff for any such
past or future costs, including records of prior payments to plaintiff or to
third parties therefor;

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(b) Documents evidencing social security benefits covering plaintiff for any
such past or future costs, including records of prior payments to plaintiff or
to third parties therefor;
(c) Documents evidencing workers' compensation or employee benefit
program coverage in favor of plaintiff for any such past or future costs,
including records of prior payments to plaintiff or to third parties therefor,
along with HIPAA compliant authorizations permitting the release of such
records;
(d) Documents that evidence any other form of collateral source benefits in
favor of plaintiff for any such past or future costs, including records of prior
payments to plaintiff or to third parties therefor, along with HIPAA
compliant authorizations permitting the release of such records from all
available collateral source providers;
(e) Any agreements reflecting plaintiff entitlement to any collateral source
benefits referred to in (a) through (d) above; and
(f) Documents evidencing any premiums paid by plaintiff for a two-year period
before the date of the alleged incident for any collateral source benefits
referred to in (a) through (d) above.

12. Copies of all documents supporting each item of alleged special damage.

13. If plaintiff is eligible for Medicare Benefits or becomes Medicare-eligible during

the pendency of this lawsuit, plaintiff to provide the following:

(a) Any and all documents concerning any payments or reimbursements made
by Medicare in connection with any medical services you have received, or
expenses you have incurred, which are alleged to be related to your injuries
in this action, including, but not limited to medical bills, explanations of
benefits (EOBs), Medicare Rights and Responsibilities Letter, Medicare
Conditional Payment Letters, Medicare Conditional Payment Notice,
Medicare Final Demand Letter, and/or any other correspondence from
Medicare, including the Centers for Medicare & Medicaid Services (CMS),
the Medicare Secondary Payer Recovery Contractor (MSPRC) and/or the
Coordination of Benefits Contractor (COBC).
(b) A duly executed and completed Questionnaire from the Centers for
Medicare & Medicaid Services (CMS) to determine Medicare eligibility.
(A questionnaire to be completed by plaintiff is attached hereto.)
(c) A duly executed and completed CMS Consent to Release Information. (An
authorization to be completed by plaintiff is attached hereto).
(d) A duly executed and completed Consent for the Release of Information
from the Social Security Administration. (An authorization to be completed
by plaintiff is attached hereto).

PLEASE TAKE FURTHER NOTICE, that in lieu of physical production of the

aforesaid documents at the above-stated time and place, defendants ALMONTE MILL FOOD

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CORP., ALMONTE MILL FOOD CORP. D/B/A KEY FOOD SUPERMARKET, and T.F.

REALTY (M.B.) CORP. shall deem this Notice satisfied by plaintiff photocopying the aforesaid

items and mailing copies thereof to defendants’ attorney by regular mail on or before November

29, 2023.

Dated: New York, New York
November 9, 2023

Yours, etc.,

LANDMAN CORSI BALLAINE & FORD P.C.

By: /s/ Joseph Capraro
Joseph Capraro
Attorneys for Defendants
ALMONTE MILL FOOD CORP.,
ALMONTE MILL FOOD CORP. D/B/A KEY
FOOD SUPERMARKET, and T.F. REALTY
(M.B.) CORP.
120 Broadway 13th Floor
New York, New York 10271
(212) 238-4800

TO: Domenic M. Recchia, Esq.
DOMENIC M. RECCHIA JR. ESQ
Attorney for Plaintiff
172 Gravesend Neck Road
Brooklyn, New York 11223
(718) 336-5550

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OCA Official Form No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of Health]

Patient Name Date of Birth Social Security Number

Patient Address

I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule ofthe Health Insurance Portability and Accountability Act of 1996
(HIPAA), I understand that:
I. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is
prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are
responsible for protecting my rights.
3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
7. Name and address ofhealth provider or entity to release this information:

8. Name and address ofperson(s) or category of person to whom this information will be sent:
Landman Corsi Ballaine and Ford P.C.. 120 Broadwav. 13th Floor. New York. NY 10271
9(a). Specific information to be released:
□Medical Record from (insert date) to (insert date)
□Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
□Other: Include: (Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) □ By initialing here I authorize
Initials Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:

(Attorney/Finn Name or Governmental Agency Name)
IO. Reason for release of information: 11. Date or event on which this authorization will expire:
□ At request of individual
□ Other:
12. If not the patient, name ofperson signing form: 13. Authority to sign on behalf ofpatient:

All items on this form have been completed and my questions about this form have been answered. In addition, I have been provided a
copy ofthe form.

Date:
-------------
Signature of patient or representative authorized by law.
Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could
---=« V «vmtoms or infection and information regarding a person's contacts.
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Instructions for the Usc
ofthe HIPAA-compliant Authorization Form to
Release Health Information Needed for Litigation

This form is the product of a collaborative process between the New York State
Office of Court Administration, representatives of the medical provider community in
New York, and the bench and bar, designed to produce a standard official form that
complies with the privacy requirements of the federal Health Insurance Portability and
Accountability Act ("HIPAA") and its implementing regulations, to be used to authorize
the release of health information needed for litigation in New York State courts. It can,
however, be used more broadly than this and be used before litigation has been
commenced, or whenever counsel would find it useful.

The goal was to produce a standard HIPAA-compliant official form to obviate the
current disputes which often take place as to whether health information requests made in
the course of litigation meet the requirements of the HIPAA Privacy Rule. It should be
noted, though, that the form is optional. This form may be filled out on line and
downloaded to be signed by hand, or downloaded and filled out entirely on paper.

When filing out Item 11, which requests the date or event when the authorization
will expire, the person filling out the form may designate an event such as "at the
conclusion of my court case" or provide a specific date amount of time, such as "3 years
from this date".

If a patient seeks to authorize the release of his or her entire medical record, but
only from a certain date, the first two boxes in section 9(a) should both be checked, and
the relevant date inserted on the first line containing the first box.

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•• 4506 Request for Copy of Tax Return
{Oct ob e r 2020) ► Do not sign this form unless all applicable lines have been completed. 0MB No. 1545-0429
► Request may be rejected if the form is incomplete or illegible.
Department of the Treas ury
Internal Rev enue Service ► For more information about Form 4506, visit www.irs.gov/form4506.
Tip. You may be able to get your tax return or return information from other sources. If you had your tax return completed by a paid preparer, they
should be able to provide you a copy of the return. The IRS can provide a Tax Return Transcript for many returns free of charge. The transcript
provides most of the line entries from the original tax return and usually contains the information that a third party (such as a mortgage company)
requires. See Form 4506-T, Request for Transcript of Tax Return, or you can quickly request transcripts by using our automated self-help service
tools. Please visit us at IRS.gov and click on "Get a Tax Transcript..." or call 1-800-908-9946.

1a Name shown on tax return. If a joint return, enter the name shown first. 1 b First social security number on tax return,
individual taxpayer identification number, or
employer identification number (see instructions)

2a If a joint return, enter spouse's name shown on tax return. 2b Second social security number or individual
taxpayer identification number if joint tax return

3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)

4 Previous address shown on the last return filed if different from line 3 (see instructions)

5 If the tax return is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and telephone number.

Caution: If the tax return is being sent to the third party, ensure that lines 5 through 7 are completed before signing. (see instructions).
6 Tax return requested. Form 1040, 1120, 941, etc. and all attachments as originally submitted to the IRS, including Form(s) W-2,
schedules, or amended returns. Copies of Forms 1040, 1040A, and 1040EZ are generally available for 7 years from filing before they are
destroyed by law. Other returns may be available for a longer period of time. Enter only one return number. If you need more than one
type of return, you must complete another Form 4506. ► _
7
Note: If the copies must be certified for court or administrative proceedings, check here .
Year or period requested. Enter the ending date of the tax year or period using the mm/dd/yyyy format (see instructions).
□
I I I I I I I I

I I I I I I

8 Fee. There is a $43 fee for each return requested. Full payment must be included with your request or it will
be rejected. Make your check or money order payable to "United States Treasury." Enter your SN, ITIN,
or EIN and "Form 4506 request" on your check or money order.
a Cost for each return . $
b Number of returns requested on line 7 .
c Total cost. Multiply line Sa by line 8b. $
9 If we cannot find the tax return, we will refund the fee. If the refund should go to the third party listed on line 5, check here
Caution: Do not sign this form unless all applicable lines have been completed.
□
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax return
requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, partner,
managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to
execute Form 4506 on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.
[] Signatory attests that he/she has read the attestation clause and upon so reading
declares that he/she has the authority to sign the Form 4506. See instructions. Phone number of taxpayer on line
1a or 2a

► Signature {see instructions) Date
Sign
Here ► PrinVfype name Title (if line 1a above is a corporation, partnership, estate, or trust)

► Spouse's signature Date

► PrinVfype name
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 41721E Fo rm 4506 (Rev. 10-20 2 0)

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Form 4506 (Rev. 10-2020) Page 2
lndlvfduals. Copies of jointly filed tax returns may
Section references are to the Internal Revenue Code Chart for all other returns be furnished to either spouse. Only one signature is
unless otherwise noted. required. Sign Form 4506 exactly as your name
For returns not in appeared on the original return. If you changed your
Future Developments Form 1040 series, name, also sign your current name.
Mail to:
For the latest information about Form 4506 and its if the address on Corporations. Generally, Form 4506 can be
instructions, go to www.irs.gov/form4506. the return was in: signed by: (1) an officer having legal authority to bind
the corporation, (2) any person designated by the
General Instructions Arizona, Arkansas, board of directors or other governing body, or (3)
Connecticut, Delaware, any officer or employee on written request by any
C a ution: Do not sign this form unless all applicable
Georgia, Indiana, Maine, principal officer and attested to by the secretary or
lines, including lines 5 through 7, have been other officer. A bona fide shareholder of record
completed. Maryland,
Massachusetts, owning 1 percent or more of the outstanding stock
Des ignate d R e c ipie nt N otifi c at ion. Internal Internal Revenue Service of the corporation may submit a Form 4506 but must
Michigan, New
Revenue Code, Section 6103(c), limits disclosure RAJVS Team provide documentation to support the requester's
Hampshire, New Jersey,
and use of return Information received pursuant to Stop 6705 S-2 right to receive the information.
New York, North
the taxpayer's consent and holds the recipient Kansas City, MO
Carolina, Ohio, Partnerships. Generally, Form 4506 can be
subject to penalties for any unauthorized access, 64999
Pennsylvania, Rhode signed by any person who was a member of the
other use, or redisclosure without the taxpayer's Island, South Carolina, partnership during any part of the tax period
express permission or request. Tennessee, Vermont, requested on line 7.
Taxpa y e r N otifi c at ion . Internal Revenue Code, Virginia, West Virginia,
Wisconsin All others. See section 6103(e) if the taxpayer has
Section 6103(c), limits disclosure and use of return died, is insolvent, is a dissolved corporation, or if a
information provided pursuant to your consent and trustee, guardian, executor, receiver, or
holds the recipient subject to penalties, brought by administrator is acting for the taxpayer.
private right of action, for any unauthorized access, Alabama, Alaska,
other use, or redisclosure without your express Arizona, Arkansas, N ote : If you are Heir at law, Next of kin, or
permission or request. California, Colorado, Beneficiary you must be able to establish a material
Florida, Hawaii, Idaho, interest in the estate or trust.
Purpose of form. Use Form 4506 to request a copy Illinois, Iowa, Kansas,
of your tax return. You can also designate (on line 5) D oc um e ntati on. For entities other than individuals,
Louisiana, Minnesota,
a third party to receive the tax return. Mississippi, Missouri, you must attach the authorization document. For
Montana, Nebraska, example, this could be the letter from the principal
H ow long wi ll It ta k e ? It may take up to 75
Nevada, New Mexico, officer authorizing an employee of the corporation or
calendar days for us to process your request. Internal Revenue Service the letters testamentary authorizing an individual to
North Dakota,
Whe re to file . Attach payment and mail Form 4506 RAJVSTeam act for an estate.
Oklahoma, Oregon,
to the address below for the state you lived in, or the P.O. Box 9941
South Dakota, Texas, Signature by a rep resentat ive . A representative
state your business was in, when that return was Mail Stop 6734
Utah, Washington, can sign Form 4506 for a taxpayer only if this
filed. There are two address charts: one for Ogden, UT 84409
Wyoming, a foreign authority has been specifically delegated to the
individual returns (Form 1040 series) and one for all country, American representative on Form 2848, line 5a. Form 2848
other returns. Samoa, Puerto Rico, showing the delegation must be attached to Form
If you are requesting a return for more than one Guam, the 4506.
year or period and the chart below shows two Commonwealth of the
different addresses, send your request based on the Northern Mariana Privacy A c t a nd Pa perwork Re duc tion A ct
address of your most recent return. Islands, the U.S. Virgin N otic e . We ask for the information on this form to
Islands, or AP.O. or establish your right to gain access to the requested
Chart for individual returns F.P.O. address return(s) under the Internal Revenue Code. We need
(Form 1040 series) this information to property identify the retum(s) and
respond to your request. If you request a copy of a
If you filed an Specific Instructions tax return, sections 6103 and 6109 require you to
individual return Mail to: provide this information, including your SSN or EIN,
and lived in: Line 1b. Enter the social security number (SSN) or to process your request. If you do not provide this
individual taxpayer identification number (ITIN) for information, we may not be able to process your
Florida, Louisiana, the individual listed on line 1a, or enter the employer request. Providing false or fraudulent information
Mississippi, Texas, a identification number (EIN) for the business listed on may subject you to penalties.
foreign country, American line 1 a. For example, if you are requesting Form
Internal Revenue Service 1040 that Includes Schedule C (Form 1040), enter Routine uses of this information include giving it to
Samoa, Puerto Rico, the Department of Justice for civil and criminal
RAIVSTeam your SSN.
Guam, the litigation, and cities, states, the District of Columbia,
Stop 6716 AUSC
Commonwealth of the Line

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Document Filed Date

November 09, 2023

Case Filing Date

September 14, 2023

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Document for Barry Podber v. Almonte Mill Food Corp., Almonte Mill Food Corp.D/B/A Key Food Supermarket, Shoreview Gardens Company, Llc

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