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.
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FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 09/21/2022
REGISTRATION CARD-(Men born on or after January 1, 1922 and on or before June 30, 1924)
SERIAL NUMBER 1. NAME (Print) ORDER NUMBER
(First) (Middle) (Last)
2. PLACE F RESIDENCE (Print)
- _ ____------__ -- - -------- ---
(Number and atreet) (Town.township. or city)
village, (County) (State)
[THE PLACE OF SIDENCE GIVEN ON THE LINE ABOVE WILL DETERMINE LOCAL BOA
URISDICTION; LINE 2 OF REGISTRATION CERTIFICATE WILL BE IDENTICAL]
3. MAIUNG AD ESS
(Mallingaddress if other than
place indicated
on line 2.
Ifsame insert
word same)
4. TELEPH E 5. AGE IN YEARS LAC F B RTH fa
(Town or county
DATE OF BIRTH
------------------__-------------__-------- ..---- ---________ - ____- _ ---- -----------... -- __--- - -__--------__---
(Erehange) (Number) (Mo.) (D ) (Yr.) (State orou ry)
7 A E AND 19DRESS OF,PER N WHO W ALWAYS OW YOUR ADDRESS
___ --- ___-- - - - __ --- - - - - -- ___ - ------------------..-----
8. EMPLOY N E AND ADDRESS
_________---------- - -------- --- _ - ---- -----..-------____--------_____----------------------------------------------
9. PLACE OF EMPLÓxMENT OR SINESS
Zreet-or-id-II.^¾u^^nin^w§^^^¯^^^^^'¯¯¯^^^^^^^^^^^^'''''¯^i^o^^^)^^^^^^^^^^^^^^^^'i5- -^--^^-- ta^t^ei'^^'
^^^^^^^^~^^^üi."mi;er-an-i t-yT
I ArrinM THAT I HAVE VERMED ABOVE ANSWERS AND THAT THEY Ann TRuE.
D. S. S. Form i 16--21630,3 ____ ___ __ _______ __
(Revised 6-1-42) (over) (Resi.trant·..i-nature>
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. 26 RECEIVED NYSCEF: 09/21/2022 REGISTRATION CARD-(Men born on or after January 1, 1922 and on or before June 30, 1924) SERIAL NUMBER 1. NAME (Print) ORDER NUMBER (First) (Middle) (Last) 2. PLACE F RESIDENCE (Print) - _ ____------__ -- - -------- --- (Number and atreet) (Town.township. or city) village, (County) (State) [THE PLACE OF SIDENCE GIVEN ON THE LINE ABOVE WILL DETERMINE LOCAL BOA URISDICTION; LINE 2 OF REGISTRATION CERTIFICATE WILL BE IDENTICAL] 3. MAIUNG AD ESS (Mallingaddress if other than place indicated on line 2. Ifsame insert word same) 4. TELEPH E 5. AGE IN YEARS LAC F B RTH fa (Town or county DATE OF BIRTH ------------------__-------------__-------- ..---- ---________ - ____- _ ---- -----------... -- __--- - -__--------__--- (Erehange) (Number) (Mo.) (D ) (Yr.) (State orou ry) 7 A E AND 19DRESS OF,PER N WHO W ALWAYS OW YOUR ADDRESS ___ --- ___-- - - - __ --- - - - - -- ___ - ------------------..----- 8. EMPLOY N E AND ADDRESS _________---------- - -------- --- _ - ---- -----..-------____--------_____---------------------------------------------- 9. PLACE OF EMPLÓxMENT OR SINESS Zreet-or-id-II.^¾u^^nin^w§^^^¯^^^^^'¯¯¯^^^^^^^^^^^^'''''¯^i^o^^^)^^^^^^^^^^^^^^^^'i5- -^--^^-- ta^t^ei'^^' ^^^^^^^^~^^^üi."mi;er-an-i t-yT I ArrinM THAT I HAVE VERMED ABOVE ANSWERS AND THAT THEY Ann TRuE. D. S. S. Form i 16--21630,3 ____ ___ __ _______ __ (Revised 6-1-42) (over) (Resi.trant·..i-nature>