Preview
FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
MOUSTAFA ABDEL RAHMAN, RESPONSE TO
REOUEST FOR BILL OF
Plaintiff,
PARTICULARS
Index No. 708598/2023
-against-
CD1 LLC & HERC RENTALS,
Defendants.
___________________________________________________________________Ç
PLAINTIFF'S SUBMISSION OF SUPPORTING EVIDENCE
Index
EXHIBITS:
EXHIBIT A: Response to request for bill of particulars . . .
Page 1-15
EXHIBIT B: Tax Documents 2020, 2021, 2022 . . . . Page 15-64
EXH1BIT C: Pictures of Injuries Caused by Defendant. . . . 65-66
Page
EXHIBIT D: Medical Records . . . . Page 67-75
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FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
--------------------------------------------------------------------X
MOUSTAFA ABDEL RAHMAN, RESPONSE TO
REQUEST FOR BILL OF
Plaintiff, PARTICULARS
Index No. 708598/2023
-against-
CD1 LLC & HERC RENTALS,
Defendants.
--------------------------------------------------------------------X
Plaintiff, MOUSTAFA ABDEL RAHMAN, by his attorney, Kareem El Nemr, Esq.,
responding to the demands of Defendant, CD1 LLC & HERC RENTALS, as and for a
Response to the Defendants’ Request for Bill of Particulars dated August 17, 2023,
respectfully submits as follows:
GENERAL OBJECTIONS
The following general objections are incorporated into each response stated below.
1. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent
that it seeks discovery beyond the limits permitted by the CPLR and the Local
Rules.
2. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent
that it demands information and/or documents that are neither relevant, nor
reasonably calculated to lead to the discovery of admissible evidence.
3. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent
that it calls for the identification of information and/or documents containing
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confidential or proprietary materials.
4. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent
that it calls for the disclosure of matters protected by the attorney-client privilege,
any other privilege, the work product doctrine, or any other immunity. Plaintiffs
will not provide such information.
5. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent
that it is duplicative and cumulative and seeks information that may be obtained
from other sources or through other means that are more convenient, efficient,
practical, less burdensome and/or less expensive.
6. Plaintiff objects to Defendant's Demand for Verified Bill of Particulars to the extent
that it seeks information that is not within Plaintiffs’ possession, custody or
control. Plaintiffs disclaim any obligation to provide information that is not within
their possession, custody or control.
7. Inadvertent production or disclosure of any information or of any documents
containing information that is confidential, privileged, was prepared in
anticipation of litigation or for trial, or is otherwise irrelevant and/or immune
from disclosure shall not constitute a waiver of any such privilege or of any
ground for objection with respect to such information or documents, the subject
matter involved, or of Plaintiffs’ rights to object to the use of any such information
or document during any subsequent proceeding in this action or elsewhere.
8. Plaintiff’s responses to the Request for Bill of Particulars are not intended to be
and shall not be deemed to be an admission of the matters stated, implied or
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assumed by any or all of the Demands. In responding to the Demands, Plaintiffs
do not waive and expressly reserve any and all objections to the authenticity,
relevance, competency, materiality or admissibility at trial of any information or
documents produced, provided, disclosed, set forth, identified or referred to in
these responses.
9. Plaintiff specifically notes that their responses represent current knowledge and
understanding with respect to the information sought and, accordingly, reserves
the right pursuant to CPLR Sec. 3042(b) to supplement, revise and/or correct its
responses as additional information becomes available.
As to the Defendant’s Demands:
1. The date of the occurrence.
The incident occurred on September 28, 2022.
2. The specific location of the occurrence.
The incident occurred at or near 19-60 41st Street, Astoria, NY 11105.
3. The date of birth of the plaintiff.
The plaintiff's date of birth is November 10, 1954.
4. The address of current residence of the plaintiff and address at time of
commencement of this action.
The address of the current residence of the plaintiff is and address at time of
commencement of this action is 20-06 37th st Astoria, NY 11105 and the address at the time
of commencement is 19-60 41st Street, Astoria, NY 11105.
5. The plaintiff’s social security number.
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The plaintiff's social security number is
6. A statement of all acts or omissions constituting the negligence claimed.
- Objection. This demand is improper, in that it calls for evidentiary material or
information in the form of, or to be gleaned from fact and expert testimony and,
therefore, such demand is overly broad, improper and beyond the scope of a bill of
particulars. Delladio v. Paul, 250 A.D.2d 806, 673 N.Y.S.2d 212 (2d Dept. 1998); Hevward
v. Ellenville Hosp., 215 A.D.2d 967, 627 N.Y.S.2d 167 (3d Dept. 1995); Patterson v. Jewish
Hosp. & Med. Ctr. of Brooklyn, 94 Misc. 2d 680, 405 N.Y.S.2d 194 (Sup. Ct., Kings Co.),
affd. 65 A.D.2d 553, 409 N.Y.S.2d 124 (2d Dept. 1978).
7. The acts or omissions constituting the alleged negligence of any named co-defendants
or other named person or entities. The plaintiff was caused to trip and fall and be
violently precipitated to the ground due to the lift that was raised and left hanging on
the sidewalk.
8. The nature of any defective or hazardous condition claimed by the plaintiff to have
existed at the time of the accident alleged in the Verified Complaint. - Defendant left the
lift raised and out hanging on the sidewalk resulting in the plaintiff's severe injuries.
9. When the alleged negligence was committed and by whom on behalf of the defendant.
- The alleged negligence was committed on September 28th 2022 by the defendant.
10. State whether actual or constructive notice is claimed.
Objection. Plaintiff hereby objects to this demand in that it improperly seeks
particularization of information that is evidentiary in nature, and therefore is not
proper for a bill of particular. The Plaintiff reserves their right to amend and/or
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supplement this response after depositions have been conducted.
10. If actual notice is claimed, then set forth following:
a. The names of the employees, agents and/or servants of the Defendant(s) to
whom it will be alleged actual notice was given. - Objection. This demand
is improper, in that it calls for evidentiary material or information in the
form of, or to be gleaned from, expert testimony and, therefore, such
demand is overly broad, improper and beyond the scope of a bill of
particulars. Delladio v. Paul. 250 A.D.2d 806, 673 N.Y.S.2d 212 (2d Dept.
1998); Hevward v. Ellenville Hosp. 215 A.D.2d 967, 627 N.Y.S.2d 167 (3d
Dept. 1995); Patterson v. Jewish Hosp. & Med. Ctr. of Brooklyn. 94 Misc.
2d 680, 405 N.Y.S.2d 194 (Sup. Ct., Kings Co.), affd. 65 A.D.2d 553, 409
N.Y.S.2d 124 (2d Dept. 1978). Moreover, the names of the employees,
agents and/or servants of the Defendant(s) to whom it will be alleged said
actual notice was given are all in the exclusive possession of Defendant,
which will be revealed during deposition testimony.
11. If constructive notice is claimed, set forth the period of time that the condition
existed.
b. Objection. Plaintiff hereby objects to this demand in that it improperly
seeks particularization of information that is evidentiary in nature, and
therefore is not proper for a bill of particulars. The Plaintiff reserves their
right to amend and/or supplement this response after depositions have
been conducted.
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12. The specific laws, statutes and/or ordinances which are claimed to have been
violated. Objection. This demand is improper, in that it calls for evidentiary
material or information in the form of, or to be gleaned from fact and expert
testimony and, therefore, such demand is overly broad, improper and beyond
the scope of a bill of particulars. Delladio v. Paul, 250 A.D.2d 806, 673 N.Y.S.2d
212 (2d Dept. 1998); Hevward v. Ellenville Hosp., 215 A.D.2d 967, 627 N.Y.S.2d
167 (3d Dept. 1995); Patterson v. Jewish Hosp. & Med. Ctr. of Brooklyn, 94 Misc.
2d 680, 405 N.Y.S.2d 194 (Sup. Ct., Kings Co.), affd. 65 A.D.2d 553, 409 N.Y.S.2d
124 (2d Dept. 1978).
13. State whether the occurrence alleged in the Verified Complaint was reported to
defendant HERC RENTALS INC. or anyone on the behalf of defendant HERC
RENTALS INC. If the occurrence was reported:
c. State the dates, times and places the occurrence was reported and the
names of the persons on behalf of defendant HERC RENTALS INC. to
whom it was reported. -The incident occurred on September 28, 2022
near 19-60 41st ,Astoria, NY 11105 and the plaintiff called the ambulance.
d. State whether the said report was in writing or verbal each time it was
reported to defendant. The report was written.
14. If defective or improper repair is claimed, state when the repairs were made and
who made the repairs on behalf of defendant.- The plaintiff is unaware of any
repairs that may have been made on behalf of the defendant.
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15. Set forth a statement of the injuries claimed to have been sustained by the
plaintiff as a result of the accident referred to in the Verified Complaint.- All
injuries sustained will be found under exhibit D.
16. Set forth a statement of the injuries claimed to have been sustained by the
plaintiff as a result of the accident referred to in the Verified Complaint. All
injuries sustained will be found under exhibit D.
17. Set forth a statement of those injuries which are claimed to be permanent. All
injuries sustained will be found under exhibit D.
18. Set forth the length of time the plaintiff was confined to home as a result of the
incident. - The plaintiff was confined to bed for a month as a result of the
incident.
19. Set forth the length of time the plaintiff was confined to bed as a result of the
incident. The plaintiff was confined to bed for a month as a result of the
incident.
20. Set forth if the plaintiff received treatment at a hospital or hospitals, the name
and address of said hospital or hospitals. The hospital and addresses in which
the plaintiff received treatment will be found under exhibit D.
21. If plaintiff received treatment from any physicians, therapists, other health care
provider, or underwent any diagnostic testing, set forth the name and address
where such treatment was received and the dates of any such treatment (s). The
hospital and addresses in which the plaintiff received treatment will be found
under exhibit D.
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22. Set forth the period of time plaintiff was incapacitated from employment as a
result of this incident. If none, so state. The plaintiff was incapacitated from
employment for a period of 4 months due to treatment and therapy as a result
of the incident.
23. If loss of earnings is claimed by Plaintiff, set forth the name and address of
plaintiff's employer at the time of the incident and the nature of plaintiff's
employment. The plaintiff is self-employed.
24. If loss of earnings is claimed by Plaintiff, set forth the specific amount claimed for
both past and future lost earnings. All loss of earnings and future lost earnings
can be calculated using the tax form found in exhibit B.
25. If loss of earnings is claimed by Plaintiff, set forth the annual earnings of plaintiff
for the three (3) years before the alleged incident. Annual earnings for the past
three years before the incident can be found in exhibit B.
26. Set forth the total amounts claimed as special damages for plaintiff for:
i. Physicians' services;
ii. Medical supplies;
iii. X-rays;
iv. Hospital expenses;
v. Nurses' services;
vi. Loss of earnings, including any claim for diminishment in future
earning capacity; and
vii. Any other special damages claimed.
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All injuries sustained will be found under exhibit D.
27. If the plaintiff received disability benefits, set forth date and amounts thereof.
PLEASE TAKE FURTHER NOTICE that failure to comply with this demand will
serve as a basis for a motion to preclude the plaintiff from offering into evidence
any of the particulars demanded herein. The plaintiff did not receive any
disability benefits.
Dated: October 28, 2023
Astoria, New York
Yours, Etc.,
_____________________
Kareem El Nemr, Esq.
Attorney for the Plaintiff
28-30 Steinway Street
Astoria, New York, 11103
Tel: 917-860-2164
Fax No: 347-507-5528
Kelnemr@elnemrlaw.com
To:
Mark D. Wellman
Attorneys for Defendant
HERC RENTALS, INC.
Wall Street Plaza, 88 Pine Street, 21st Floor New York, New York 10005
(212) 376-6400
File: 40794.00148
10
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NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
--------------------------------------------------------------------X Index: 708598/2023
MOUSTAFA ABDEL RAHMAN,
RESPONSE TO
Plaintiff, COMBINED DEMANDS
-against-
CD1 LLC & HERC RENTALS,
Defendants.
--------------------------------------------------------------------X
Plaintiff, MOUSTAFA ABDEL RAHMAN, by his attorney, Kareem El Nemr, Esq.,
responding to the demands of Defendant, CD1 LLC & HERC RENTALS, as and for a
Response to the Defendants’ Combined Demands dated August 17, 2023 , respectfully
submits as follows:
PARTY STATEMENTS
Each adverse party is to serve on us, pursuant to CPLR 3101(e) and CPLR 3120,
within thirty (30) days from the service of this Demand, a complete and legible copy of
any statement made by or taken from any individual party or any officer, agent, or
employee of said party.
Plaintiff is currently not in possession of any party statements at the time of this
writing. The Plaintiff reserves his right to amend this response, in the event that the
Plaintiff comes into possession of such evidence.
INSURANCE POLICIES
Each adverse party is to serve, pursuant to CPLR 3101(f) and CPLR 3120, within
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thirty (30) days from the service of this Demand, a complete and legible copy of each
primary or excess insurance agreement under which any person carrying on an insurance
business may be liable to satisfy part or all of any judgment which may be entered in this
action or to indemnify or reimburse for payments made to satisfy any such judgment.
ACCIDENT REPORTS
Each adverse party is to serve, pursuant to CPLR 3101(g) and CPLR 3120, within
thirty (30) days from service of this Demand, a complete and legible copy of every written
report of the accident or other event alleged in the complaint prepared in the regular
course of that adverse party's business operations or practices.
The plaintiff does not have a copy of the accident reports. The Plaintiff reserves his
right to amend this response, in the event that the Plaintiff comes into possession of
such evidence.
PHOTOGRAPHS AND VIDEOTAPES
Each adverse party is to serve within thirty (30) days from the service of this
Demand, complete and legible photographic or videotape reproductions of any and all
photographs, or video films of the items damaged.
Plaintiff is currently not in possession of any photographs and/or video footage
of the accident at the time of this writing. The Plaintiff reserves his right to amend this
response, in the event that the Plaintiff comes into possession of such evidence.
WITNESSES
Each adverse party is to serve within thirty (30) days from the service of this
Demand, the name and address of each witness to any of the following:
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1. The accident, occurrence or any other event set forth in the complaint. - The
Plaintiff is not aware of any witnesses to this incident. The Plaintiff reserves his
right to amend this response, in the event that the Plaintiff comes into
possession of such evidence.
2. Any fact tending to prove actual or constructive notice of any condition which may
give rise to the liability of any person, whether or not a party, for any damages
alleged in this action. - The Plaintiff is not aware of any witnesses to this
incident. The Plaintiff reserves his right to amend this response, in the event
that the Plaintiff comes into possession of such evidence.
3. Any admission, statement, writing or act of our client. - The Plaintiff is not aware
of any witnesses to this incident. The Plaintiff reserves his right to amend this
response, in the event that the Plaintiff comes into possession of such evidence.
EXPERT WITNESS MATERIAL
Each adverse party is to serve, pursuant to CPLR 3101(d)(1), within thirty (30) days
from the service of this request, a statement specifying all of the following data as to each
person whom that adverse party expects to call as an expert witness at trial on who has
appraised the loss for an insurance company: The Plaintiff has not retained any expert
witnesses to this incident. The Plaintiff reserves his right to amend this response, in
the event that the Plaintiff comes into possession of such evidence.
1. The identity of each expert; The Plaintiff has not yet retained any expert
witnesses in connection with this lawsuit. Plaintiff reserves his right to amend
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and/or supplement this response, once an expert witness is retained.
2. The subject matter on which each expert is expected to testify, disclosed in
reasonable detail; The Plaintiff has not yet retained any expert witnesses in
connection with this lawsuit. Plaintiff reserves his right to amend and/or
supplement this response, once an expert witness is retained.
3. The substance of the facts and opinions on which each expert is expected to testify;
The Plaintiff has not yet retained any expert witnesses in connection with this
lawsuit. Plaintiff reserves his right to amend and/or supplement this response,
once an expert witness is retained.
4. The qualifications of each expert; The Plaintiff has not yet retained any expert
witnesses in connection with this lawsuit. Plaintiff reserves his right to amend
and/or supplement this response, once an expert witness is retained.
5. A summary of the grounds for each expert's opinion. The Plaintiff has not yet
retained any expert witnesses in connection with this lawsuit. Plaintiff reserves
his right to amend and/or supplement this response, once an expert witness is
retained.
NAMES AND ADDRESSES OF ATTORNEYS
Each adverse party is to serve on us, within thirty (30) days from service of this
Demand, the names and addresses of all attorneys having appeared in this action on
behalf of any adverse party.
Kareem El Nemr, Esq.
Attorney for the Plaintiff
28-30 Steinway Street
Astoria, New York, 11103
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Tel: 917-860-2164
Fax No: 347-507-5528
Kelnemr@elnemrlaw.com
Mark D. Wellman
Attorneys for Defendant
HERC RENTALS, INC.
Wall Street Plaza, 88 Pine Street, 21st Floor New York, New York 10005
(212) 376-6400
File: 40794.00148
October 28, 2023
Astoria, New York
Yours, Etc.,
_____________________
Kareem El Nemr, Esq.
Attorney for the Plaintiff
28-30 Steinway Street
Astoria, New York, 11103
Tel: 917-860-2164
Fax No: 347-507-5528
Kelnemr@elnemrlaw.com
To:
Mark D. Wellman
Attorneys for Defendant
HERC RENTALS, INC.
Wall Street Plaza, 88 Pine Street, 21st Floor New York, New York 10005
(212) 376-6400
File: 40794.00148
15
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NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024
FOR TAX YEAR 2021
MOUSTAFA A ABDELROHMAN
TAX WORKS INC
3 0 0 7 43RD STREET
Astoria, NY 11103
( 6 4 6 ) 662-3703
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Department
of theTreasury-,ntemal
Revenueservice (99)
21040- R u.s. Tax naturn for seniors I 2021 l
o.....,s...oo,4 insu..on.,-o.n... ......,,...,n........
O Single O Marriedfiling jointly O Married filing separately (MFS)
Filing
Status 8 Head of household (HOH) D Qualifying widow(er) (Q W)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the childs
Check only
one box. nameif
the qualifying person is a child but not your dependent. »
Your first name and middle initial Last name Yoursocial securny number
MoUSTAFA A ABDELROHMAN 45 2
If joint retum. spouse's first name and middle Initial Last name spouse'ssocial security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election campaign
Check here if you, or your
2 o 06 37 TH ST
'
City, town or post office. If you have a foreign address, also complete spaces below. State ZIP code
As toria trr | 11105 (;henking a bn× hnIow wm
Foreign country name Foreign province/state/county Foreign postal code not change your tax or
refund. You spouse
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any
financial interest in any virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . º Yes No
Someone can claim: D You as a dependent Your spouse as a dependent
Standard
Deduction O Spouse itemizes on a separate return or you were a dual-status alien
You: 8 Were bom befon [ O Are blind
Age/Blindness
Spouse: O Was bom before O Is Mind
Dependents (2) social secunty (3) Relationship to (4) check If quallfles for (see Instructions):
(see instructions): (1) First name Last name
numh m Child tax credit crea,,forog er dependen,S
If more than four FAROUK ABDELROHMAN 38 5 Son
dependents. see
Instructions and
check here B
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . 1
Attach 2a Tax-exempt interest . . . . 2a . . . . . 2b
b Taxable interest ss
Schedule B
if required. 3a Qualified dividends . ... 3a b Ordinary dividends . . . 3b
4a IRA distributions . . . . . . 4a b Taxable amount . . . . . 4b
Sa Pensions and annuities . . Sa b Taxable amount . . . . . 5b
6a Social security benefits . . 6a b Taxable amount . . . . . 6b
7 Capital gain or (loss). Attach Schedule D if required. If not required,
check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . º O 7
8 Other income from Schedule 1, line 10. . . . . . . . . . . . . . . . . . . . . . . . . . 8 18 , 219
9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total Income . . . . . . . . > 9 1s , 27s
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . 10
11 Subtract line 10 from line 9. This is your adjustedgross income . . . . . . . . > 11 is , 27s
For Disclemure. Privacy Act. and Paperwork Reduction Act Notice. see separate Instructions. Form 1040-SR (2021)
EEA
17
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Farm 1040-SR (2021) MOUSTAFA A ABDELROHMAN 52 Page2
Standard
12a Standard deductionoritemixed deductions (from
Deduction
Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12a
Deduct chart b Charitablecontributionsif you take the standard
°"¹he astpag°
deduction (see instructions) . . . . . . . . . . . . . . . . . . . 12b
of this form
c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c soo
20,
13 Qualified businessincomedeductionfrom Form 8995 or Form 8995-A . . . . . . 13
14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 soo
20,
15 Taxableincome.Subtractline 14 from line 11. If zeroorless,enter-0- . . . . . 15 o
16 Tax (seeinstructions). Checkif any from:
10 Form(s) 8814 20 Form 4972 30 . . . . . . . . . . . 16 o
17 AmountfromSchedule 2, line3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 o
19 Nonrefundable child taxcredit or credit forotherdependents from
Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Amount fromSchedule 3, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 a
22 Subtractline 21 fromline 18. If zero or less, enter-0- . . . . . . . . . . . . . . . . 22 o
23 Other taxes, including self-employmenttax, from Schedule 2,line 21 . . . . . . . 23
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . . . . . . 24 o
25 Federalincome tax withheld from:
a Form(s)W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
c Other forms (see instructions) . . . . . . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d
26 2021 estimated tax payments and amountapplied from2020retur1 . . . . . . . 26
If you have 27a Earned Income credit (EIC) . . . . . . . . . . . . . . . . . . . 27a
Check here if you wereborn after January 1, 1998,
Sch. EIC. and before 2, 2004, and you all the
January satisfy
otherrequirements for taxpayers who are atleast
age 18 to claim the EIC. Seeinstructions . . . . . . . . > ¡
b Nontaxable combat pay election . . . 27
c Prior year(2019) eamed income . . . 27c 17, 493
28 Refundable child tax credit or additional child tax
creditfrom Schedule 8812 . . . . . . . . . . . . . . . . . . . . 28
29 American opportunity creditfrom Form 8863,line 8 . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . . 30 o
31 Amount from Schedule 3, IIne 15 . . . . . . . . . . . . . . . . 31 n..-
32 Add lines27a and28through31. Theseare your totalother payments
and refundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > 32 3,s1a
33 Add lines 25d, 26,and 32.These are your total payments . . . . . . . . . . . . º 33
3, 61s
Go to wwwks.gov/Form104OSRfor instructions and the latest Informatbn. orm 1040-SR (202n
EEA
18
FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024
Preview
FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS MOUSTAFA ABDEL RAHMAN, RESPONSE TO REOUEST FOR BILL OF Plaintiff, PARTICULARS Index No. 708598/2023 -against- CD1 LLC & HERC RENTALS, Defendants. ___________________________________________________________________Ç PLAINTIFF'S SUBMISSION OF SUPPORTING EVIDENCE Index EXHIBITS: EXHIBIT A: Response to request for bill of particulars . . . Page 1-15 EXHIBIT B: Tax Documents 2020, 2021, 2022 . . . . Page 15-64 EXH1BIT C: Pictures of Injuries Caused by Defendant. . . . 65-66 Page EXHIBIT D: Medical Records . . . . Page 67-75 1 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS --------------------------------------------------------------------X MOUSTAFA ABDEL RAHMAN, RESPONSE TO REQUEST FOR BILL OF Plaintiff, PARTICULARS Index No. 708598/2023 -against- CD1 LLC & HERC RENTALS, Defendants. --------------------------------------------------------------------X Plaintiff, MOUSTAFA ABDEL RAHMAN, by his attorney, Kareem El Nemr, Esq., responding to the demands of Defendant, CD1 LLC & HERC RENTALS, as and for a Response to the Defendants’ Request for Bill of Particulars dated August 17, 2023, respectfully submits as follows: GENERAL OBJECTIONS The following general objections are incorporated into each response stated below. 1. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent that it seeks discovery beyond the limits permitted by the CPLR and the Local Rules. 2. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent that it demands information and/or documents that are neither relevant, nor reasonably calculated to lead to the discovery of admissible evidence. 3. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent that it calls for the identification of information and/or documents containing 2 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 confidential or proprietary materials. 4. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent that it calls for the disclosure of matters protected by the attorney-client privilege, any other privilege, the work product doctrine, or any other immunity. Plaintiffs will not provide such information. 5. Plaintiff objects to Defendant’s Demand for Verified Bill of Particulars to the extent that it is duplicative and cumulative and seeks information that may be obtained from other sources or through other means that are more convenient, efficient, practical, less burdensome and/or less expensive. 6. Plaintiff objects to Defendant's Demand for Verified Bill of Particulars to the extent that it seeks information that is not within Plaintiffs’ possession, custody or control. Plaintiffs disclaim any obligation to provide information that is not within their possession, custody or control. 7. Inadvertent production or disclosure of any information or of any documents containing information that is confidential, privileged, was prepared in anticipation of litigation or for trial, or is otherwise irrelevant and/or immune from disclosure shall not constitute a waiver of any such privilege or of any ground for objection with respect to such information or documents, the subject matter involved, or of Plaintiffs’ rights to object to the use of any such information or document during any subsequent proceeding in this action or elsewhere. 8. Plaintiff’s responses to the Request for Bill of Particulars are not intended to be and shall not be deemed to be an admission of the matters stated, implied or 3 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 assumed by any or all of the Demands. In responding to the Demands, Plaintiffs do not waive and expressly reserve any and all objections to the authenticity, relevance, competency, materiality or admissibility at trial of any information or documents produced, provided, disclosed, set forth, identified or referred to in these responses. 9. Plaintiff specifically notes that their responses represent current knowledge and understanding with respect to the information sought and, accordingly, reserves the right pursuant to CPLR Sec. 3042(b) to supplement, revise and/or correct its responses as additional information becomes available. As to the Defendant’s Demands: 1. The date of the occurrence. The incident occurred on September 28, 2022. 2. The specific location of the occurrence. The incident occurred at or near 19-60 41st Street, Astoria, NY 11105. 3. The date of birth of the plaintiff. The plaintiff's date of birth is November 10, 1954. 4. The address of current residence of the plaintiff and address at time of commencement of this action. The address of the current residence of the plaintiff is and address at time of commencement of this action is 20-06 37th st Astoria, NY 11105 and the address at the time of commencement is 19-60 41st Street, Astoria, NY 11105. 5. The plaintiff’s social security number. 4 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 The plaintiff's social security number is 6. A statement of all acts or omissions constituting the negligence claimed. - Objection. This demand is improper, in that it calls for evidentiary material or information in the form of, or to be gleaned from fact and expert testimony and, therefore, such demand is overly broad, improper and beyond the scope of a bill of particulars. Delladio v. Paul, 250 A.D.2d 806, 673 N.Y.S.2d 212 (2d Dept. 1998); Hevward v. Ellenville Hosp., 215 A.D.2d 967, 627 N.Y.S.2d 167 (3d Dept. 1995); Patterson v. Jewish Hosp. & Med. Ctr. of Brooklyn, 94 Misc. 2d 680, 405 N.Y.S.2d 194 (Sup. Ct., Kings Co.), affd. 65 A.D.2d 553, 409 N.Y.S.2d 124 (2d Dept. 1978). 7. The acts or omissions constituting the alleged negligence of any named co-defendants or other named person or entities. The plaintiff was caused to trip and fall and be violently precipitated to the ground due to the lift that was raised and left hanging on the sidewalk. 8. The nature of any defective or hazardous condition claimed by the plaintiff to have existed at the time of the accident alleged in the Verified Complaint. - Defendant left the lift raised and out hanging on the sidewalk resulting in the plaintiff's severe injuries. 9. When the alleged negligence was committed and by whom on behalf of the defendant. - The alleged negligence was committed on September 28th 2022 by the defendant. 10. State whether actual or constructive notice is claimed. Objection. Plaintiff hereby objects to this demand in that it improperly seeks particularization of information that is evidentiary in nature, and therefore is not proper for a bill of particular. The Plaintiff reserves their right to amend and/or 5 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 supplement this response after depositions have been conducted. 10. If actual notice is claimed, then set forth following: a. The names of the employees, agents and/or servants of the Defendant(s) to whom it will be alleged actual notice was given. - Objection. This demand is improper, in that it calls for evidentiary material or information in the form of, or to be gleaned from, expert testimony and, therefore, such demand is overly broad, improper and beyond the scope of a bill of particulars. Delladio v. Paul. 250 A.D.2d 806, 673 N.Y.S.2d 212 (2d Dept. 1998); Hevward v. Ellenville Hosp. 215 A.D.2d 967, 627 N.Y.S.2d 167 (3d Dept. 1995); Patterson v. Jewish Hosp. & Med. Ctr. of Brooklyn. 94 Misc. 2d 680, 405 N.Y.S.2d 194 (Sup. Ct., Kings Co.), affd. 65 A.D.2d 553, 409 N.Y.S.2d 124 (2d Dept. 1978). Moreover, the names of the employees, agents and/or servants of the Defendant(s) to whom it will be alleged said actual notice was given are all in the exclusive possession of Defendant, which will be revealed during deposition testimony. 11. If constructive notice is claimed, set forth the period of time that the condition existed. b. Objection. Plaintiff hereby objects to this demand in that it improperly seeks particularization of information that is evidentiary in nature, and therefore is not proper for a bill of particulars. The Plaintiff reserves their right to amend and/or supplement this response after depositions have been conducted. 6 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 12. The specific laws, statutes and/or ordinances which are claimed to have been violated. Objection. This demand is improper, in that it calls for evidentiary material or information in the form of, or to be gleaned from fact and expert testimony and, therefore, such demand is overly broad, improper and beyond the scope of a bill of particulars. Delladio v. Paul, 250 A.D.2d 806, 673 N.Y.S.2d 212 (2d Dept. 1998); Hevward v. Ellenville Hosp., 215 A.D.2d 967, 627 N.Y.S.2d 167 (3d Dept. 1995); Patterson v. Jewish Hosp. & Med. Ctr. of Brooklyn, 94 Misc. 2d 680, 405 N.Y.S.2d 194 (Sup. Ct., Kings Co.), affd. 65 A.D.2d 553, 409 N.Y.S.2d 124 (2d Dept. 1978). 13. State whether the occurrence alleged in the Verified Complaint was reported to defendant HERC RENTALS INC. or anyone on the behalf of defendant HERC RENTALS INC. If the occurrence was reported: c. State the dates, times and places the occurrence was reported and the names of the persons on behalf of defendant HERC RENTALS INC. to whom it was reported. -The incident occurred on September 28, 2022 near 19-60 41st ,Astoria, NY 11105 and the plaintiff called the ambulance. d. State whether the said report was in writing or verbal each time it was reported to defendant. The report was written. 14. If defective or improper repair is claimed, state when the repairs were made and who made the repairs on behalf of defendant.- The plaintiff is unaware of any repairs that may have been made on behalf of the defendant. 7 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 15. Set forth a statement of the injuries claimed to have been sustained by the plaintiff as a result of the accident referred to in the Verified Complaint.- All injuries sustained will be found under exhibit D. 16. Set forth a statement of the injuries claimed to have been sustained by the plaintiff as a result of the accident referred to in the Verified Complaint. All injuries sustained will be found under exhibit D. 17. Set forth a statement of those injuries which are claimed to be permanent. All injuries sustained will be found under exhibit D. 18. Set forth the length of time the plaintiff was confined to home as a result of the incident. - The plaintiff was confined to bed for a month as a result of the incident. 19. Set forth the length of time the plaintiff was confined to bed as a result of the incident. The plaintiff was confined to bed for a month as a result of the incident. 20. Set forth if the plaintiff received treatment at a hospital or hospitals, the name and address of said hospital or hospitals. The hospital and addresses in which the plaintiff received treatment will be found under exhibit D. 21. If plaintiff received treatment from any physicians, therapists, other health care provider, or underwent any diagnostic testing, set forth the name and address where such treatment was received and the dates of any such treatment (s). The hospital and addresses in which the plaintiff received treatment will be found under exhibit D. 8 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 22. Set forth the period of time plaintiff was incapacitated from employment as a result of this incident. If none, so state. The plaintiff was incapacitated from employment for a period of 4 months due to treatment and therapy as a result of the incident. 23. If loss of earnings is claimed by Plaintiff, set forth the name and address of plaintiff's employer at the time of the incident and the nature of plaintiff's employment. The plaintiff is self-employed. 24. If loss of earnings is claimed by Plaintiff, set forth the specific amount claimed for both past and future lost earnings. All loss of earnings and future lost earnings can be calculated using the tax form found in exhibit B. 25. If loss of earnings is claimed by Plaintiff, set forth the annual earnings of plaintiff for the three (3) years before the alleged incident. Annual earnings for the past three years before the incident can be found in exhibit B. 26. Set forth the total amounts claimed as special damages for plaintiff for: i. Physicians' services; ii. Medical supplies; iii. X-rays; iv. Hospital expenses; v. Nurses' services; vi. Loss of earnings, including any claim for diminishment in future earning capacity; and vii. Any other special damages claimed. 9 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 All injuries sustained will be found under exhibit D. 27. If the plaintiff received disability benefits, set forth date and amounts thereof. PLEASE TAKE FURTHER NOTICE that failure to comply with this demand will serve as a basis for a motion to preclude the plaintiff from offering into evidence any of the particulars demanded herein. The plaintiff did not receive any disability benefits. Dated: October 28, 2023 Astoria, New York Yours, Etc., _____________________ Kareem El Nemr, Esq. Attorney for the Plaintiff 28-30 Steinway Street Astoria, New York, 11103 Tel: 917-860-2164 Fax No: 347-507-5528 Kelnemr@elnemrlaw.com To: Mark D. Wellman Attorneys for Defendant HERC RENTALS, INC. Wall Street Plaza, 88 Pine Street, 21st Floor New York, New York 10005 (212) 376-6400 File: 40794.00148 10 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS --------------------------------------------------------------------X Index: 708598/2023 MOUSTAFA ABDEL RAHMAN, RESPONSE TO Plaintiff, COMBINED DEMANDS -against- CD1 LLC & HERC RENTALS, Defendants. --------------------------------------------------------------------X Plaintiff, MOUSTAFA ABDEL RAHMAN, by his attorney, Kareem El Nemr, Esq., responding to the demands of Defendant, CD1 LLC & HERC RENTALS, as and for a Response to the Defendants’ Combined Demands dated August 17, 2023 , respectfully submits as follows: PARTY STATEMENTS Each adverse party is to serve on us, pursuant to CPLR 3101(e) and CPLR 3120, within thirty (30) days from the service of this Demand, a complete and legible copy of any statement made by or taken from any individual party or any officer, agent, or employee of said party. Plaintiff is currently not in possession of any party statements at the time of this writing. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. INSURANCE POLICIES Each adverse party is to serve, pursuant to CPLR 3101(f) and CPLR 3120, within 11 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 thirty (30) days from the service of this Demand, a complete and legible copy of each primary or excess insurance agreement under which any person carrying on an insurance business may be liable to satisfy part or all of any judgment which may be entered in this action or to indemnify or reimburse for payments made to satisfy any such judgment. ACCIDENT REPORTS Each adverse party is to serve, pursuant to CPLR 3101(g) and CPLR 3120, within thirty (30) days from service of this Demand, a complete and legible copy of every written report of the accident or other event alleged in the complaint prepared in the regular course of that adverse party's business operations or practices. The plaintiff does not have a copy of the accident reports. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. PHOTOGRAPHS AND VIDEOTAPES Each adverse party is to serve within thirty (30) days from the service of this Demand, complete and legible photographic or videotape reproductions of any and all photographs, or video films of the items damaged. Plaintiff is currently not in possession of any photographs and/or video footage of the accident at the time of this writing. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. WITNESSES Each adverse party is to serve within thirty (30) days from the service of this Demand, the name and address of each witness to any of the following: 12 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 1. The accident, occurrence or any other event set forth in the complaint. - The Plaintiff is not aware of any witnesses to this incident. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. 2. Any fact tending to prove actual or constructive notice of any condition which may give rise to the liability of any person, whether or not a party, for any damages alleged in this action. - The Plaintiff is not aware of any witnesses to this incident. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. 3. Any admission, statement, writing or act of our client. - The Plaintiff is not aware of any witnesses to this incident. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. EXPERT WITNESS MATERIAL Each adverse party is to serve, pursuant to CPLR 3101(d)(1), within thirty (30) days from the service of this request, a statement specifying all of the following data as to each person whom that adverse party expects to call as an expert witness at trial on who has appraised the loss for an insurance company: The Plaintiff has not retained any expert witnesses to this incident. The Plaintiff reserves his right to amend this response, in the event that the Plaintiff comes into possession of such evidence. 1. The identity of each expert; The Plaintiff has not yet retained any expert witnesses in connection with this lawsuit. Plaintiff reserves his right to amend 13 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 and/or supplement this response, once an expert witness is retained. 2. The subject matter on which each expert is expected to testify, disclosed in reasonable detail; The Plaintiff has not yet retained any expert witnesses in connection with this lawsuit. Plaintiff reserves his right to amend and/or supplement this response, once an expert witness is retained. 3. The substance of the facts and opinions on which each expert is expected to testify; The Plaintiff has not yet retained any expert witnesses in connection with this lawsuit. Plaintiff reserves his right to amend and/or supplement this response, once an expert witness is retained. 4. The qualifications of each expert; The Plaintiff has not yet retained any expert witnesses in connection with this lawsuit. Plaintiff reserves his right to amend and/or supplement this response, once an expert witness is retained. 5. A summary of the grounds for each expert's opinion. The Plaintiff has not yet retained any expert witnesses in connection with this lawsuit. Plaintiff reserves his right to amend and/or supplement this response, once an expert witness is retained. NAMES AND ADDRESSES OF ATTORNEYS Each adverse party is to serve on us, within thirty (30) days from service of this Demand, the names and addresses of all attorneys having appeared in this action on behalf of any adverse party. Kareem El Nemr, Esq. Attorney for the Plaintiff 28-30 Steinway Street Astoria, New York, 11103 14 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 Tel: 917-860-2164 Fax No: 347-507-5528 Kelnemr@elnemrlaw.com Mark D. Wellman Attorneys for Defendant HERC RENTALS, INC. Wall Street Plaza, 88 Pine Street, 21st Floor New York, New York 10005 (212) 376-6400 File: 40794.00148 October 28, 2023 Astoria, New York Yours, Etc., _____________________ Kareem El Nemr, Esq. Attorney for the Plaintiff 28-30 Steinway Street Astoria, New York, 11103 Tel: 917-860-2164 Fax No: 347-507-5528 Kelnemr@elnemrlaw.com To: Mark D. Wellman Attorneys for Defendant HERC RENTALS, INC. Wall Street Plaza, 88 Pine Street, 21st Floor New York, New York 10005 (212) 376-6400 File: 40794.00148 15 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 FOR TAX YEAR 2021 MOUSTAFA A ABDELROHMAN TAX WORKS INC 3 0 0 7 43RD STREET Astoria, NY 11103 ( 6 4 6 ) 662-3703 16 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 Department of theTreasury-,ntemal Revenueservice (99) 21040- R u.s. Tax naturn for seniors I 2021 l o.....,s...oo,4 insu..on.,-o.n... ......,,...,n........ O Single O Marriedfiling jointly O Married filing separately (MFS) Filing Status 8 Head of household (HOH) D Qualifying widow(er) (Q W) If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the childs Check only one box. nameif the qualifying person is a child but not your dependent. » Your first name and middle initial Last name Yoursocial securny number MoUSTAFA A ABDELROHMAN 45 2 If joint retum. spouse's first name and middle Initial Last name spouse'ssocial security number Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election campaign Check here if you, or your 2 o 06 37 TH ST ' City, town or post office. If you have a foreign address, also complete spaces below. State ZIP code As toria trr | 11105 (;henking a bn× hnIow wm Foreign country name Foreign province/state/county Foreign postal code not change your tax or refund. You spouse At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . º Yes No Someone can claim: D You as a dependent Your spouse as a dependent Standard Deduction O Spouse itemizes on a separate return or you were a dual-status alien You: 8 Were bom befon [ O Are blind Age/Blindness Spouse: O Was bom before O Is Mind Dependents (2) social secunty (3) Relationship to (4) check If quallfles for (see Instructions): (see instructions): (1) First name Last name numh m Child tax credit crea,,forog er dependen,S If more than four FAROUK ABDELROHMAN 38 5 Son dependents. see Instructions and check here B 1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . 1 Attach 2a Tax-exempt interest . . . . 2a . . . . . 2b b Taxable interest ss Schedule B if required. 3a Qualified dividends . ... 3a b Ordinary dividends . . . 3b 4a IRA distributions . . . . . . 4a b Taxable amount . . . . . 4b Sa Pensions and annuities . . Sa b Taxable amount . . . . . 5b 6a Social security benefits . . 6a b Taxable amount . . . . . 6b 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . º O 7 8 Other income from Schedule 1, line 10. . . . . . . . . . . . . . . . . . . . . . . . . . 8 18 , 219 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total Income . . . . . . . . > 9 1s , 27s 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . 10 11 Subtract line 10 from line 9. This is your adjustedgross income . . . . . . . . > 11 is , 27s For Disclemure. Privacy Act. and Paperwork Reduction Act Notice. see separate Instructions. Form 1040-SR (2021) EEA 17 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024 Farm 1040-SR (2021) MOUSTAFA A ABDELROHMAN 52 Page2 Standard 12a Standard deductionoritemixed deductions (from Deduction Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12a Deduct chart b Charitablecontributionsif you take the standard °"¹he astpag° deduction (see instructions) . . . . . . . . . . . . . . . . . . . 12b of this form c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c soo 20, 13 Qualified businessincomedeductionfrom Form 8995 or Form 8995-A . . . . . . 13 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 soo 20, 15 Taxableincome.Subtractline 14 from line 11. If zeroorless,enter-0- . . . . . 15 o 16 Tax (seeinstructions). Checkif any from: 10 Form(s) 8814 20 Form 4972 30 . . . . . . . . . . . 16 o 17 AmountfromSchedule 2, line3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 o 19 Nonrefundable child taxcredit or credit forotherdependents from Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 20 Amount fromSchedule 3, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 21 Add lines 19and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 a 22 Subtractline 21 fromline 18. If zero or less, enter-0- . . . . . . . . . . . . . . . . 22 o 23 Other taxes, including self-employmenttax, from Schedule 2,line 21 . . . . . . . 23 24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . . . . . . 24 o 25 Federalincome tax withheld from: a Form(s)W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 c Other forms (see instructions) . . . . . . . . . . . . . . . . . . 25c d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d 26 2021 estimated tax payments and amountapplied from2020retur1 . . . . . . . 26 If you have 27a Earned Income credit (EIC) . . . . . . . . . . . . . . . . . . . 27a Check here if you wereborn after January 1, 1998, Sch. EIC. and before 2, 2004, and you all the January satisfy otherrequirements for taxpayers who are atleast age 18 to claim the EIC. Seeinstructions . . . . . . . . > ¡ b Nontaxable combat pay election . . . 27 c Prior year(2019) eamed income . . . 27c 17, 493 28 Refundable child tax credit or additional child tax creditfrom Schedule 8812 . . . . . . . . . . . . . . . . . . . . 28 29 American opportunity creditfrom Form 8863,line 8 . . . . . 29 30 Recovery rebate credit. See instructions . . . . . . . . . . . 30 o 31 Amount from Schedule 3, IIne 15 . . . . . . . . . . . . . . . . 31 n..- 32 Add lines27a and28through31. Theseare your totalother payments and refundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > 32 3,s1a 33 Add lines 25d, 26,and 32.These are your total payments . . . . . . . . . . . . º 33 3, 61s Go to wwwks.gov/Form104OSRfor instructions and the latest Informatbn. orm 1040-SR (202n EEA 18 FILED: QUEENS COUNTY CLERK 01/15/2024 12:19 PM INDEX NO. 708598/2023 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/15/2024