On November 03, 2022 a
Party Statement
was filed
involving a dispute between
Deanna Marie Tucker,
and
Mary T. Bassett M.D., M.P.H.
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 11/03/2022 12:55 PM INDEX NO. 908334-22
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 11/03/2022
EXHIBIT A
Birth Certificate of Petitioner Deanna Marie Beckley
FILED: ALBANY COUNTY CLERK 11/03/2022 12:55 PM INDEX NO. 908334-22
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 11/03/2022
33 7
OHIO DEPARTMENT OF HEALTH
DIVISION OF VITAL STATISTICS - .
"*''''''''
nor. mst. wo. CERTIFICATE OF LIVE BIRTH
/Jo 73 055054
Primary Reg.DIst, No.
Birth No.
CHII..D-NAME First Middle Last DATE OF BIRTH (Month, Day, Year) HOUR
BECKLE 20. 2L '. a.
SEX IF NOT SINGLEBIRTH-Born
THISBIRTH--eing.1e,twin, triplet. etc. UN
first, second, C F BIRTH
(Specify) third, etc. (Specify)
3. FEMALE 4.. SINGT,E 46. 3.. HAMILTON
CITY, VILL.AGE. OR L.OCATION OF BIRTH INSIDECITYLIMITS HOSPITAL-NAME (If not in hospital,givestreetandnumber)
(Specifyyesor no)
sL. CINCINNATI 3. 3d.
MOTHER-MAIDEN NAME First IWiddle Last AGE (At time of STATEOF BIRTH(If not in U.S.A..namecountry)
this birth)
6.. DIANA LO_M_0NICO a. e. NEW YORK
, < 8
RESIDENCE-51ATE COUNTY CITY,VILLAGE,OR LOCATION AND NUMBER
INSIDECITYLIMITS STREET
yesor
ISpecify no)
. OHIO 7d. CLERMONT 7cN d.
FATHER-NAME First Middle Last AGE(At time of STATEOFBIRTH(If not In U.S.A..namecountry)
this birth)
Z 8a. R sL. sc. ORTO
(NF MANT'S NAME OR SIGNATURE RELATIONTO CHILD
e I hat the abovenamedchild was
ally the andtime andon the date DATESIGNED ANT-M.D.,D.O., midwife, ottter
10o. SIGNATURE - ff '
106. J 7 0
CERTIFIER-NAME cry orrrin) MAILlHG ADDRESS (Streetor R.F.D. No.,City or Villafg, State,Zip)
iod. DR. J GRAY oe.
REGISTRAR-SIGNATURE DATERECEIVEDY LO L REGISTRAR
Judith B. Nagy
Ragistrar
State
- 2021
O CT 6
I HEREBY CERTIFY THIS DOCUMENT IS AN EXACT COPY OF THE RECORD ONFILE WITH THE OHIO DEPARTMENT OF HEALTF
REV.7/201E
Document Filed Date
November 03, 2022
Case Filing Date
November 03, 2022
Category
Special Proceedings - CPLR Article 78
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FILED: ALBANY COUNTY CLERK 11/03/2022 12:55 PM INDEX NO. 908334-22 NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 11/03/2022 EXHIBIT A Birth Certificate of Petitioner Deanna Marie Beckley FILED: ALBANY COUNTY CLERK 11/03/2022 12:55 PM INDEX NO. 908334-22 NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 11/03/2022 33 7 OHIO DEPARTMENT OF HEALTH DIVISION OF VITAL STATISTICS - . "*'''''''' nor. mst. wo. CERTIFICATE OF LIVE BIRTH /Jo 73 055054 Primary Reg.DIst, No. Birth No. CHII..D-NAME First Middle Last DATE OF BIRTH (Month, Day, Year) HOUR BECKLE 20. 2L '. a. SEX IF NOT SINGLEBIRTH-Born THISBIRTH--eing.1e,twin, triplet. etc. UN first, second, C F BIRTH (Specify) third, etc. (Specify) 3. FEMALE 4.. SINGT,E 46. 3.. HAMILTON CITY, VILL.AGE. OR L.OCATION OF BIRTH INSIDECITYLIMITS HOSPITAL-NAME (If not in hospital,givestreetandnumber) (Specifyyesor no) sL. CINCINNATI 3. 3d. MOTHER-MAIDEN NAME First IWiddle Last AGE (At time of STATEOF BIRTH(If not in U.S.A..namecountry) this birth) 6.. DIANA LO_M_0NICO a. e. NEW YORK , < 8 RESIDENCE-51ATE COUNTY CITY,VILLAGE,OR LOCATION AND NUMBER INSIDECITYLIMITS STREET yesor ISpecify no) . OHIO 7d. CLERMONT 7cN d. FATHER-NAME First Middle Last AGE(At time of STATEOFBIRTH(If not In U.S.A..namecountry) this birth) Z 8a. R sL. sc. ORTO (NF MANT'S NAME OR SIGNATURE RELATIONTO CHILD e I hat the abovenamedchild was ally the andtime andon the date DATESIGNED ANT-M.D.,D.O., midwife, ottter 10o. SIGNATURE - ff ' 106. J 7 0 CERTIFIER-NAME cry orrrin) MAILlHG ADDRESS (Streetor R.F.D. No.,City or Villafg, State,Zip) iod. DR. J GRAY oe. REGISTRAR-SIGNATURE DATERECEIVEDY LO L REGISTRAR Judith B. Nagy Ragistrar State - 2021 O CT 6 I HEREBY CERTIFY THIS DOCUMENT IS AN EXACT COPY OF THE RECORD ONFILE WITH THE OHIO DEPARTMENT OF HEALTF REV.7/201E