On September 20, 2022 a
Exhibit,Appendix
was filed
involving a dispute between
Deborah V Grey,
and
Mary T Bassett Md Mpn
The Commissioner, New York State Department Of Health,
for Special Proceedings - CPLR Article 78
in the District Court of Albany County.
Preview
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 09/21/2022
Exhibits S, T
FORMULA A
FORMULE A
STATO: ITALIA SERVIZIO DÈLLO STATO CIVILE DI AIROLA
2
ETAT: SERVICE DE L'ÉTAT CIVIL DE
ESTRATTO DELL'ATTO DI NASCITA N5 0 P . I anno 190 0
3
EXTRAIT DE L'ACTE DE NAISSANCE N.
Giorno Mese Anno
DATA E LUOGO DI NASCITA Jo Mo An AIROLA
DATE ET LIEU DE NAISSANCE 07 04 1900 ITAL IA
COGNOME DELLA PERUTA
5 NOM
PRENOMI MARIA
6 pagNOMS
SESSO F PADRE MADRE
SEXE PERE
9 MERE
,
COGNOME DELLA PERUTA PASCARELLA
5 NOM
PRENOMI GENNARO MARIA ANTONIA
Ó PRÉNOMS
ALTRE ENUNCIAZIONI DELL'ATTO
AUTRE ÉNONCIATIONS DE L'ACTE
DATA Dr IHLÃS' IO, Giorno Mese Anno
- Mo An
11 FIRMA BOLLO
09 2 2 O2 2
DATE DE DÉLIVRANCE, FICIAdi Dik. mTO CIVILE
SIGNATURE, SCEAU L'UFFICI i15 ATf3STATO CIVILE
DiSilvestro Anna Madä
SYMBOLES / ZEICHEN / SYMBOLS / SIMBOLOS / £YMBOAA/ SIMBOLI / SYMBOLEN / SIMBOLOS / ISARETLER /SIMBOLI
- / Dag / Dia / Gün / Dan
/ Giorno
Jo: Jour / Tag / Day / Dia / ‰µéÁ±
- Mo: Mois / Monat/ Month / Mes / M®v / Mese / Maand / Mesec
/ Mes / Ay
- An: Année / Anno
/ Jahr / Year / Año / ˆto / Jaar / Ano
/ Yul / Godina
- M: Masculin / M5nnlich / Masculino
/ Masculine / 'Appsy / Mannelijk
/ Maschile / Masculino/ Erkek
/ Muaki
- F: Féminin/ Weiblich/ Feminine/ Femenino/ 0®»o Vrouwelijk
/ Femminilei/ / Feminino / }enski
/ Kadin
- Mar: Mariage / Matrimonio
/ Marriage
/ EheschlieGung / rµog/ Matrimonio/ Huwelijk/ Casamento/ Evlenme/Zakljuenje braka
- Sc: Séparation von Tisch
de corps / Trennung und Bett / Legal
separation /
aÀó ÄÁ±À鶷 x±1 xoir·Â
personal / XÉÁtõóÂ
/ Separación
Separazionepersonale/ Scheidung en bed / Separação de pessoas e bens / Aynlik
van tafel / Fizika rastava
- Div: Divorce/ Scheidung / Divorcio
/ Divorce / At±¶úytov / Echtscheiding
/ Divorzio / Bo_anma / Razvod
/ Divórcio
- A: Annulation / Annulment
/ Nichtigerklarung / Anulación
/ 'AKúÁÉÃt / Annullamento / Anulação
/ Nietigverklaring / Ponittenje
/ Iptal
- D: Décès / Tod / Death
/ Defunción
/ 0¬v±toÂ/ Morte / Óbito
/ Overlijden / Olümn/ Smrt
- Dm: del marido
des Ehemanns / Death of the husband / Defunción
Décès du mari / Tod / 0¬v±toÂtoo ou¶úyoo del marito
/ Morte /
Overlijden do marido
van de man / Óbito / Kocanm olomü / Smrt mu~a
- / Defunción
/ Death of the wife
/ Tod der Ehefrau
Décès de la femme de la mujer
/ 0¬v±roqt®Â ou¶úyou / Morte /
della moglie
Df:
Overlijdenvan de vrouw/ Óbitoda mulher/ Kannm olumü / Smrtfene
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 09/21/2022
paM.E.-Tam nervonastrre aATE m ma
DEPAR¶NENY DFNEALTH
. 590 2 mREAoor ST*t RecoRos
==TEm---- onaTreisays or omann a st00 2 5Ûf
172 TYPE ALL EMTRtE50R15RtIf r ANENT
I N PEltl BLACit RNA.
1. H M4E, FIRST sip!DhLIE 3.,s$7 E. ep c L ¾ ar eemy 33, geong
ung rtwas.g; p#419 whvt *
IBRIA FASSARD 03 02 70 '6:4
ALbilAltantlietSAms,ETC t ungos941GM*L 949pttp' M1M DATESCF $1:Ry1EL
Es isn is upwis o
white 66 a s a
a. e..T. mm are No.em e-mL*Epo.tamamv. pm, a--meon nua- mwov
PlainWa· ****'" "' *"a
C
ite
larrison t <8
festcheste arrison Day
., St Agnes Hospital
a m m.T..
nosmTnn i s wer us
..emer--..--
wouTu my *EAm
a c.m.:,, -
cctneTa'Fr
)
---,L .-4 us hs.son-mm sm.a ar -FE,----a. a
Thaly 4 8 03 U.S.A. Widowed
House Work i Own Home 73-46-4808
m. smTe lue. cau.rT I me mm t wo ev an malus. man TwE ar.5m= aumaEn
I I I componAre uw?w I
1West- t -ea «*
g 91 Congress St.
N.Y. Chester ‰arrison Harrigon
sT annoLg war nFre man s waT
Gennaro Pert1to Antionette (unknown)
m.mmon-TwE, hee. amnemEss: a.m.uaE Em Eaon
John Massaro 87 Webster Ave. Harrison N.Y.
{L waisip5rkTE
CA.,BE
D,L 7012 As A f.0 4 G 0F
ann-Trams. wasy, naiE
MS MI thvi)JRE@rkTg(3)
emuss.t At nTmumTicc
tMGEBr..itttG
£22s$ELA!FT M4E SEhEESF
BarET4 da A5 A 4
fift
eaÁi"tt emEm s ammcA4T caMct'ricas $0MSA$N4 C6uTRIBUTl&ETO iBA kJtc93r? tat tF YE!5,WEREFINDINDIGB"NDSM40(M
DEATH T OT R1ELATED gingm muHAhT ( Ik'
ra ga jg>g. Yt5 MG 5s4*HC"AME 6F BEATHP
u£TAEst--sM
29E inaunT AT womer n uF maum nour, I no. onT revums a na., s,Är on vwsm.mn. rovrr. ,¼AT4
1E5 WO OF#yit
F4ti'92t. 1 $3 Etc.
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etnT
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PLAEEGF GUNtat
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Kenneth S. Krom (J.-4
one ane n 2==. won a ata aswo *e-- as
BAVE
'""* 3
.: f ih 170 se a .. t 41 70
Document Filed Date
September 21, 2022
Case Filing Date
September 20, 2022
Category
Special Proceedings - CPLR Article 78
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FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 09/21/2022 Exhibits S, T FORMULA A FORMULE A STATO: ITALIA SERVIZIO DÈLLO STATO CIVILE DI AIROLA 2 ETAT: SERVICE DE L'ÉTAT CIVIL DE ESTRATTO DELL'ATTO DI NASCITA N5 0 P . I anno 190 0 3 EXTRAIT DE L'ACTE DE NAISSANCE N. Giorno Mese Anno DATA E LUOGO DI NASCITA Jo Mo An AIROLA DATE ET LIEU DE NAISSANCE 07 04 1900 ITAL IA COGNOME DELLA PERUTA 5 NOM PRENOMI MARIA 6 pagNOMS SESSO F PADRE MADRE SEXE PERE 9 MERE , COGNOME DELLA PERUTA PASCARELLA 5 NOM PRENOMI GENNARO MARIA ANTONIA Ó PRÉNOMS ALTRE ENUNCIAZIONI DELL'ATTO AUTRE ÉNONCIATIONS DE L'ACTE DATA Dr IHLÃS' IO, Giorno Mese Anno - Mo An 11 FIRMA BOLLO 09 2 2 O2 2 DATE DE DÉLIVRANCE, FICIAdi Dik. mTO CIVILE SIGNATURE, SCEAU L'UFFICI i15 ATf3STATO CIVILE DiSilvestro Anna Madä SYMBOLES / ZEICHEN / SYMBOLS / SIMBOLOS / £YMBOAA/ SIMBOLI / SYMBOLEN / SIMBOLOS / ISARETLER /SIMBOLI - / Dag / Dia / Gün / Dan / Giorno Jo: Jour / Tag / Day / Dia / ‰µéÁ± - Mo: Mois / Monat/ Month / Mes / M®v / Mese / Maand / Mesec / Mes / Ay - An: Année / Anno / Jahr / Year / Año / ˆto / Jaar / Ano / Yul / Godina - M: Masculin / M5nnlich / Masculino / Masculine / 'Appsy / Mannelijk / Maschile / Masculino/ Erkek / Muaki - F: Féminin/ Weiblich/ Feminine/ Femenino/ 0®»o Vrouwelijk / Femminilei/ / Feminino / }enski / Kadin - Mar: Mariage / Matrimonio / Marriage / EheschlieGung / r¬µog/ Matrimonio/ Huwelijk/ Casamento/ Evlenme/Zakljuenje braka - Sc: Séparation von Tisch de corps / Trennung und Bett / Legal separation / aÀó ÄÁ±À鶷 x±1 xoir·Â personal / XÉÁtõó / Separación Separazionepersonale/ Scheidung en bed / Separação de pessoas e bens / Aynlik van tafel / Fizika rastava - Div: Divorce/ Scheidung / Divorcio / Divorce / At±¶úytov / Echtscheiding / Divorzio / Bo_anma / Razvod / Divórcio - A: Annulation / Annulment / Nichtigerklarung / Anulación / 'AKúÁÉÃt / Annullamento / Anulação / Nietigverklaring / Ponittenje / Iptal - D: Décès / Tod / Death / Defunción / 0¬v±toÂ/ Morte / Óbito / Overlijden / Olümn/ Smrt - Dm: del marido des Ehemanns / Death of the husband / Defunción Décès du mari / Tod / 0¬v±toÂtoo ou¶úyoo del marito / Morte / Overlijden do marido van de man / Óbito / Kocanm olomü / Smrt mu~a - / Defunción / Death of the wife / Tod der Ehefrau Décès de la femme de la mujer / 0¬v±roqt®Â ou¶úyou / Morte / della moglie Df: Overlijdenvan de vrouw/ Óbitoda mulher/ Kannm olumü / Smrtfene FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 09/21/2022 paM.E.-Tam nervonastrre aATE m ma DEPAR¶NENY DFNEALTH . 590 2 mREAoor ST*t RecoRos ==TEm---- onaTreisays or omann a st00 2 5Ûf 172 TYPE ALL EMTRtE50R15RtIf r ANENT I N PEltl BLACit RNA. 1. H M4E, FIRST sip!DhLIE 3.,s$7 E. ep c L ¾ ar eemy 33, geong ung rtwas.g; p#419 whvt * IBRIA FASSARD 03 02 70 '6:4 ALbilAltantlietSAms,ETC t ungos941GM*L 949pttp' M1M DATESCF $1:Ry1EL Es isn is upwis o white 66 a s a a. e..T. mm are No.em e-mL*Epo.tamamv. pm, a--meon nua- mwov PlainWa· ****'" "' *"a C ite larrison t <8 festcheste arrison Day ., St Agnes Hospital a m m.T.. nosmTnn i s wer us ..emer--..-- wouTu my *EAm a c.m.:,, - cctneTa'Fr ) ---,L .-4 us hs.son-mm sm.a ar -FE,----a. a Thaly 4 8 03 U.S.A. Widowed House Work i Own Home 73-46-4808 m. smTe lue. cau.rT I me mm t wo ev an malus. man TwE ar.5m= aumaEn I I I componAre uw?w I 1West- t -ea «* g 91 Congress St. N.Y. Chester ‰arrison Harrigon sT annoLg war nFre man s waT Gennaro Pert1to Antionette (unknown) m.mmon-TwE, hee. amnemEss: a.m.uaE Em Eaon John Massaro 87 Webster Ave. Harrison N.Y. {L waisip5rkTE CA.,BE D,L 7012 As A f.0 4 G 0F ann-Trams. wasy, naiE MS MI thvi)JRE@rkTg(3) emuss.t At nTmumTicc tMGEBr..itttG £22s$ELA!FT M4E SEhEESF BarET4 da A5 A 4 fift eaÁi"tt emEm s ammcA4T caMct'ricas $0MSA$N4 C6uTRIBUTl&ETO iBA kJtc93r? tat tF YE!5,WEREFINDINDIGB"NDSM40(M DEATH T OT R1ELATED gingm muHAhT ( Ik' ra ga jg>g. Yt5 MG 5s4*HC"AME 6F BEATHP u£TAEst--sM 29E inaunT AT womer n uF maum nour, I no. onT revums a na., s,Är on vwsm.mn. rovrr. ,¼AT4 1E5 WO OF#yit F4ti'92t. 1 $3 Etc. O O j -0R CE NG HLY mom , 11L101MCBERTGF1917u#95Lthe5. DEATH©ÇAu*RED&T A4 stVM4Banas F E44ui¬tearnqMAND hirEW)G4TfGlef IN wY PUGT3 %$E M©s*TMEAYi %E.APE AT TA*ETfM5t}'9 ©PtMaht8E4764SCE©5ME*J 4Wh¾h©t MM , THET1542,ENEft MapuPLAILtApeD emrsu-nAtn.4s ear wonM 94 ran 205vT** o - n giq cÁ , AtTsweemsantsvew, .. ec q ya etnT iF eTitEn trun FtEn t - co*mi"E* e"res"Man. tr "e·" ycastette PLAEEGF GUNtat hiths was. Meet"|n hatr REAR 22.11L LDEATitP)itsTT DB VG QFRwAhomen alttHGski,. 222. Æ 47 A 5tf |AL CNEhdATsan O O 3 5 0 Mt. Cem. Greenburg, N.b MtSRftV8%% WA¶W>&W rammat | aws- a Calvary t°®5 P* "''"*" " 4et manaommux maus, varn a.^m a· 6 002610 o-or ,ue ----mana .m.we, mEaa mazEm Kenneth S. Krom (J.-4 one ane n 2==. won a ata aswo *e-- as BAVE '""* 3 .: f ih 170 se a .. t 41 70