Preview
FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM INDEX NO. EF2017-0115
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018
Index # : EF2017-0115
.JUEST FOR JUDICIAL INTERVENTION For Court C
UCS-840 (7/2012) 1ASEntry DATE
SUPREME COURT, COUNTY OF TOMPKINS
Index No: EF2017-0115 Date index Issued 06/28/2017
Jud ¾ned
,' O'O'PllON:—
CAPTION: Enter thecomplete case capbon. Do not use etal or et anolf morespace is RJf pate
\.
attach
re_quired, a captionnder sheet
AMERICAN ADVISORS GROUP,
Plaintiff(s)/Petitioner(s)
-a ainst-
LAW '
ROGER D. VAN ETTEN (AKA) RODGER D. VANETTEN (DECEASED); DALE VAN ETTEN AS HEfR AT AND NEXT OF
KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A RODGER VA; DOUGLAS VAN ETTEN AS HEIR AT LAW
AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A RODGER VA; REGINA BANFIELD AS
HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A RODGER VAN; TABATHA I
VAN ETTEN MONAHAN AS HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A
R; TANYA PARSONS AS HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D, VAN ETTEN A/K/A
Defendant(s)/Respondent(s)
0'n]ye -'
',:
'
, NATURE OF ACTION OR PROCEEDING: '';;,', ":,::.:. =-' '
Check oNE box oniy and specify where indicated. ".:.'.: .
MATRIMONIAL ...: COMMERCIAL
Contested 0 Business Entity (including corporations, partnerships, LLCs, etc.)
NOTE: For all Matrimonial
actions where the parties have children under the age of
0 Contract
18, complete and attach the MATRIMONIAL
RJI Addendum For Uncontested 0 insurance (whereinsureris a party, except
arbitration)
Matnmonial actions, use IUl
form UD-13. ,.0 UCC sales,
(including negotiableinstruments)
, TORTS ' .::: " ..:, '',, 0 Other
,0 Commercial:
Asbestos (SpecifY)
O Breast Implant '
NOTE: For Commercial Division assignment requests (22 NYCRR
Environmental 202.70(d)), complete and attach the COMMERCIAL DIV RJi Addendum.
(specify)
'i;,
Medical,Dental,or Podiatric
Malpractice REAL PROPERTY: -. How many properties does the application include?
0 Motor Vehicle
10 Condemnation
O Products Liability:
.8 MortgageForeclosure
(speci )
Property Address:1954 CODDINGTON ROAD. BROOKTONDALE NY 14817
Other Negligence:
Street Address City State Zip
(specify)
O Other Professional NOTE: For Foreclosure actions invoMng a one- to four-family, owner
Malpractice. occupied, residential property, or an owner-occupied condominium
Malpractice:
complete and attach the FORECLOSURE RJi Addendum
(specify)
0 Tax Certiarari - Section: Block: Lot:
O Other Tort
(specify) O TAX FORECLOSURE
Other Real Property:
._.-.- . . . (specify)
i
OTHER MATTERS —:
_ ..:: ': ___—'.:::::.:.:
'::::::::...: .: ..
.::.:-'.:::::, SPECIAL PROCEEDINGS
Certificate of Incorporation/Dissolution [see NOTE under Commerciaij 0 CPLR Article 75 (Arbitration) [see NOTE under Cornmerc a ]
Emergency Medical Treatment O CPLR Article 78 (Body or Officer)
:0
Hebeas Corpus O Election Law
,:0
Local Court Appeal 0 MHLAdicle 9.60 (Kendra's Law)
Mechanic's Lien O MHLArticle 10 (Sex Offender Confinement-Initial)
:0
Name Change O MHL Article 10 (Sex Offender Confinement-Review)
:,0
Pistol Permit Revocation Hearing 0 MHL Article 81 (Guardianship)
O Other Mental Hygiene:
.0
Sale or Finance of Religious/Not-for-Profit Property
(specify)
Other:
(specify) 0 Other Special Proceeding:
STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated,
YES NO
Has a summons and complaintor summons w/noticebeen filed? 8 0 If yes, date filed:
06/28/2017
Has a summons and complaintor summons w/noticebeen served? 8 0 If yes, date
served:_07/03/2017
07/03/2017
Is this being
action/proceeding post-judgment?
filed 0 () If yesjudgment date
1 of 4
FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM INDEX
Index NO.
#: EF2017-0115
EF2017-0115
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018
NATURE OFýÇÇlplAÜNTERVENTION . Chepk ONE box only ÃND enteradditional
informatioJi)vher
in'dicatdd.
o Infant's
Cornprornise
o Note of Issue
and/or of Readiness
Certificate
o Noticeof Medical,
Dental,or Podiatric
Malpractice Date IssueJoined:
o Noticeof Motion ReliefSought: Motionto CancelLP an Discontinuethe Action ReturnDate:
o Noticeof Petition Relief
Sought: Return Date:
o Orderto Show Cause Relief
Sought: Return Date:
o OtherEx Parte Application ReliefSought
o Poor PersonApplication
o Request for Preliminary
Conference
X ResidentialMortgage ForeclosureSettlernent
Conference
o Writof Habeas Corpus
o Other(specifyt
' ' '' .'
LISI 'any rota!et tinilyCourt cascsr i
actions. For Mnatrunotiial actions, include any related crl'mtnaI and/jr . '':, -, ..; I
If nOnC,Iea'yeblaIllc
If additiOnal SpaCCiS required, COmpletCand attaCh the RJI Adderidunx
. .. . .Cas
Case
('.asc e i hide3/Case do. court ud e pf_assigned) to Instant
Relationship
,Relationship Case
.
.........._......_.............. ..... .
. .......----___.__..... .. _...___________. .. . ....- . .
. ..........-...
........_..... . -.
.. ------
tf additional space Is required, complete and attiich the RJI Addendum.
Far Pa(Ice WithOutan attOrney CheCk"UnReP" bOXAND enter Party addieSS, PhOnenumber and e mail addreSSin "AttOinceyS"
n i PaOe,
-; --,-::-.
Parties: . Attorneys: Issue
Un- Listpartiesincaptionindiaandindicate atforneys' '' .
partyrole(s) Provide name, firm name, businessaddress,phone number and email
addressol
of attorneys
at) Joined Insurance Carriests
Rep
-
* 3rd-party
(58 defendant; '
plaintift) .' '
thai have appearedin the ease,
tbsthavcappcarcdlathccase.
' ' '..' D//Ix{)-
(Y/N):
,''American
Advisors
Group ROSICKI.ROSICKI
& ASSOCIATES,
P.C
YES
FirmName 0
26HARVESTERAVENUE BATAVIA sty . O NO
14020 .0
f ]; kola
Pr:mary
1, ' I'iamlil1' Street
address City State Zip
Plaintitr
';
RoleOfany)
Secondary
,Plainnll'
' Plaintiff . Phone585-815.0288Fat 585-815-0299 e-mailattorneyconf@roswki
com
- -.........__._- ..... .
.. ... ......
-..... -- . _..........._..
.. . .... . . .... . .
DALEVANETTENASHEIRATLAWAND DALEVANErrhN ASHEIRATLAWANDNEXTOFKINOFROGER VANETTEN
NENTOFKIN OFROGERVANETTENA/K/A .' A/K/AROGER
D VANETTENA/K/ARODGER VA
ROGERD.VANETTENA/K/A RODGERVA LastName FirstNanw
LastName O NO
,OiVO
FirmName
DALEVANETTINASHETRATLAWAND .
NEXTOFKIN OFROGERVANETTENA/K/A LOOP460.CROSSVILLE
55GARRISON , TN38555
ROGERD.VANETTENA/K/ARODGERVA Street
address City State Zip
FirstName
Role
Primary
oI
1
. '
I DOUGLASVANETTENASHElHAT LAWAND DOUGLA$VANETTENASHEIRATLAWANDNEXTOFKINOFROGER VAN
P itIES
p
NEXTOFKIN OFROGERVANETTENA/K/A i ETTENA/K/AROGER
D VANETTENA'K/ARODGERVA
ROGERD,VANFTTENA/K/ARODGERVA LastName FirstName
LastName O NO
FirmName
DOUGLASVANETTENASHEIRATi'tT LAWAND
I I NEXTOFKIN OFROGERVANETTENA/K/A 342MAGNOLIARD, RF.IDSVlLLE
. GA30453
ROGERD.VANETTENA/K/A RODGERVA Sticetaddress City State Zip
FirstName
Role
Primary
Defendant Phone rax e-mail
Role(ifany):
Secondary
Defendmat
MILLER,SHARONM. MILLER,SHARONM
LastName LastName FirstName 1
MILLER,SHARONM. FirmName 0 140
ienmc
IVnmc
FirstName
I Il 64SHEFFIELD
PrimaryRole RD, ITHACA,NY 14850
i Defendant address
Street City State Zip
Role(if any):
Secondar3
I Deicndant
Phone Fas e-n1ail
T'
NEWYORKSTATEDEPARTMENT OF NEWYORKSTATEDEPARTMENT OFTAXATION& FINANCE
TAXATION&
ia FINANCE LastName FirstName j
last Name
FirmName i O NO
NEWYORKSTATEDEPAHTMENTOF
I]I]I TAXATION4 FINANCE 350MAINST,STE300A.HUFFALO,
NY 14202
FirstName Street
address City State Zip
PrimaryRole
Defendang
' Role(if any):
Secondary Phone Fax e-mait
Defeadaot
Defendant
2 of 4
FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM INDEXIndex NO.
#: EF2017-0115
EF2017-0115
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018
...-........
........ ................--.............. -....................-----....
...............................___................
..
.....................--.....-........_...
PEOPLEOFTHESTATEOFNEWYORKC/O | PEOPLEOFTHESTATEOFNEWYORKC/OITHACAC[TYCOURT
ITHACACITYCOURT LastName FirstName O YES
LastName
FirmName O NO
:ONO
PEOPLEOFTHESTATEOFNEWYORKC/O
ITHACACITYCOURT 118E CLINTONSTREET.
ITHACA,NY 14850
FirstName Streetaddress City State Zip
PrimaryRole
',Defendant
Role(if any):
Secondary Phone Fax e-mail
Defsndsni
REGINABANFIELDASHEIRATLAWAND = REGINABANFIELDASHEIRATLAWANDNEXTOFKINOFROGER VANETTEN I
; NEXTOFKIN OFROGERVANETTENAfK/A i A/K/AROGERD.VANETTENA/K/ARODGERVAN O YES
! ROGERD.VANETTENA/K/A RODGERVAN LastName FirstName
LastName O NO
FirmName
REGINABANFIELDASHEIRATLAWAND
l NEXTOFKIN OFROGERVANETTENA/K/A 174OLD$TAGERD, GROTON,NY 13073
I ROGERD.VANETTENA/K/ARODGERVAN Streetaddress City State Zip
FirstName
PrimaryRole
; Defendant Phone Fax e-mad
Role(if any):
Secondary
Defendant
SUPPORTCOLLECTIONUNITO/B/O SUPPORTCOLLECTIONUNITO/B/OSHARONM.MlLLER
SHARONM. MILLER LastName FirstName
LastName
FirmName O NO
,'0
$UPPORT COLLECTIONUNITO/B/0
I I SHARONM. MILLER CSEU420WESTSTATE ITHACA,N
STREET, Y 14850
."v'Y
FirstName ! Streetaddress City State Zip
PrimaryRole
; Defendant
Role(if any): Phone Fax e-mail
'! DefendantSecondary
SUPPORTCOLLECTIONUNITO/B/OTRACY SUPPOKI'
SUPPORTCOLLECTIONUNITOiB/OTRACYL EISTICE
L EISTICE LastName FirstName
LastName
FirmName 0 NO
SUPPORT COLLECTIONUNITO/B/OTRACY .
I I: L EISTICE CSEU-320
WESTSTATE ITHACA,NY 14850
STRE£T,
FirstName Streetaddress City State Zip
PrimaryRo[c
; Defendant
Role(if any):
Secondary Phone Fax e-mail
Defendans
TABATHAVANETTENMONAHANASHEIR TABATHAVANETTENMONAHANASHEIRATLAWANDNEXTOFKINOFROGER
ATLAWANDNEXTOFKIN OFROGERVAN VANETTENA K/AROGER D.VANETTENA/K/AR O y)
| ETTENA/K/A ROGERD.VANETTENA/K/AR LastName FirstName
LastName i0 NO
FirmName
. TABATHAVANETTENMONAHAN ASHEIR
I I . ATLAWANDNEXTOFKIN OFROGERVAN 420DOUGLAS NY 14867
RD, NEWFIELD,
i ETTENA/K/AROGERD.VANETTENA/K/AR Streetaddress City State Zip
FirstName
Role
Primary
'.Dct'endant
| Defendant Phone Fax e-mail
Role(if any):
Secondary
Defendent
....................... .. .~-_____....-..---- .....
..._.._.._...._____..... .,
TANYAPARSONS ASHEIRATLAWAND TANYAPARSONSASHElRATLAWANDNEXTOFKINOFROGER VANETTEN
NEXTOFKIN OFROGERVANETTENA/K/A AIKiAROGERD.VANETTENA/K/ARODGERVANE
ROGERD.VANETTENA/K/ARODGERVANE LastName FirstName
LastName 0 NO
Name
. TANYAPARSONS ASHEIRATLAWAND
l NEXTOFKIN OFROGERVANETTENA/K/A 525WARDBLVDW, NEWFIELD, NY 14867
ROGERD.VANETTENA/K/ARODGERVANE . Streetaddress City State Zip
FirstName
PrimaryRole
. Defendant Phone Fax e-mad
Role(ifany):
Secondary
Defendant
TOMPKINSCOUNTYDEPARTMENT OF TOMPKINSCOUNTYDEPARTMENTOF SOCIALSERVICES
SOCIALSERVICES LastName FirstName
LasEName
iVame
FirmName O NO
.:0
' TOMPKINSCOUNTYDEPARTMENT OF
I I SOCIALSERVICES 320WMARTINLUTHERKINGJR/STATESTREET, ITHACA.NY 14830
FirstName Streetaddress City State Zip
PrimaryRole
Defendan1
Role(ifany):
Secondary Phone Fax e-mail
Defendant
3 of 4
Cl2018-00676 INDEX
Index NO.
#: EF2017-0115
FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM EF2017-0115
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018
TRINITYVANETTENMONAHANASHEIRAT TRINITYVANETTENMONAHANASHElRATLAWANDNEXTOFKINOFROGER
LAWANDNEXTOFKIN OFROGERVAN . VANETTENAM/AROGER D.VANETTENA/K/AR 0 YES
VAN'
ETTENA/K/A ROGERD.VANETTENA/K/A R LastName FirstName
LastName 0 NO
FirmName
TRINITYVANETTENMONAHANASHEIRAT
.! II Kfh' OFROGERVAN
LAWANDNEXTOFKIN 525WARDBLVDW, NEWFIELD , NY14867
ETTENanus ROGERD.VANETTENA/K/A8 Streetaddress City State Zip
FirstName
PrimaryRote
Defendant Phone Fax e-mail
Role(if any)
Secondary
Defendant
UNITEDSTATESOFAMERICAO/B/O OFAMERICAO/B/OSECRETARY
UNITEDSTATES OFHOUSING & URBAN
OE'
SECRETARYOFHOUSINGar URBAN i DliVELOPN1EN1'
DEVELOPMENT ,OYES
DEVELOPMENT Lastkame FirstName
LastName 0 NO
FirmName
(N
UNITEDSTATESOFAMERICAO/B/O
I I SECRETARY OFHOUSING& URBrhh'
URBAN 271CADMANPLAZA,7THFLOOR,BROOKLYN,NY 11201
DEVELOPMENT Streetaddress City State Zip
FirstName ;
Role
Primary
Defendant Phone Fax e-mail
Role(if any):
Secondary i
Defendant
.___._......
.. . . ._... ...._____.......
.............
. ..._.......
......
... .._.. ....___...............
.. ._,....,-._........__________.......
.,... . ....._._...
.. ......-....__.____.--.---,--.--,-----·_
...._.-,.............._________.__.. __ .
VANETTEN(AKA) RODGERD.VANETTEN VANETTEN(AKA)RODGER D.VANETTEN ROGERD.
(DECEASED),
ROGERD.
(DECEASED), LastName FirstName 'OYES
Name
FirmName 0 NO
(n(O
VANETTEN(AKA)RODGERD.VANETTEN
I I ROGERD.
(DECEASED), i 1954CODDINGTON
ROAD.BROOKTONDALE,NY 14817
FirstName
iVsme
(xi&me Streetaddress City State Zip
Rote
Primary
Defendant
Role(if any):
Secondary Phone Fox e-mail
. Defendant
I AFFIRM UNDER THE PENALTY OF PERJURY THKf, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE A JAND
/AND
BEEN'' '
HAVE BEEN NO RELATED ACTIONSOR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIA INTERVE 4 †f
.Ix -VI BEEN
FILED IN THIS ACTION OR P CEEj71NG.
Dated
Signature
5150669 Eric DeBarba
ATTOR
ATTORVF i'F V REGISTRATION
REGISTRATIOVir NI JMIII'.R
NllMBl.'k IsRI/V(T OR TYPF
PRDil'I TVPF NAME
4 of 4
Preview
FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM INDEX NO. EF2017-0115 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018 Index # : EF2017-0115 .JUEST FOR JUDICIAL INTERVENTION For Court C UCS-840 (7/2012) 1ASEntry DATE SUPREME COURT, COUNTY OF TOMPKINS Index No: EF2017-0115 Date index Issued 06/28/2017 Jud ¾ned ,' O'O'PllON:— CAPTION: Enter thecomplete case capbon. Do not use etal or et anolf morespace is RJf pate \. attach re_quired, a captionnder sheet AMERICAN ADVISORS GROUP, Plaintiff(s)/Petitioner(s) -a ainst- LAW ' ROGER D. VAN ETTEN (AKA) RODGER D. VANETTEN (DECEASED); DALE VAN ETTEN AS HEfR AT AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A RODGER VA; DOUGLAS VAN ETTEN AS HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A RODGER VA; REGINA BANFIELD AS HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A RODGER VAN; TABATHA I VAN ETTEN MONAHAN AS HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D. VAN ETTEN A/K/A R; TANYA PARSONS AS HEIR AT LAW AND NEXT OF KIN OF ROGER VAN ETTEN A/K/A ROGER D, VAN ETTEN A/K/A Defendant(s)/Respondent(s) 0'n]ye -' ',: ' , NATURE OF ACTION OR PROCEEDING: '';;,', ":,::.:. =-' ' Check oNE box oniy and specify where indicated. ".:.'.: . MATRIMONIAL ...: COMMERCIAL Contested 0 Business Entity (including corporations, partnerships, LLCs, etc.) NOTE: For all Matrimonial actions where the parties have children under the age of 0 Contract 18, complete and attach the MATRIMONIAL RJI Addendum For Uncontested 0 insurance (whereinsureris a party, except arbitration) Matnmonial actions, use IUl form UD-13. ,.0 UCC sales, (including negotiableinstruments) , TORTS ' .::: " ..:, '',, 0 Other ,0 Commercial: Asbestos (SpecifY) O Breast Implant ' NOTE: For Commercial Division assignment requests (22 NYCRR Environmental 202.70(d)), complete and attach the COMMERCIAL DIV RJi Addendum. (specify) 'i;, Medical,Dental,or Podiatric Malpractice REAL PROPERTY: -. How many properties does the application include? 0 Motor Vehicle 10 Condemnation O Products Liability: .8 MortgageForeclosure (speci ) Property Address:1954 CODDINGTON ROAD. BROOKTONDALE NY 14817 Other Negligence: Street Address City State Zip (specify) O Other Professional NOTE: For Foreclosure actions invoMng a one- to four-family, owner Malpractice. occupied, residential property, or an owner-occupied condominium Malpractice: complete and attach the FORECLOSURE RJi Addendum (specify) 0 Tax Certiarari - Section: Block: Lot: O Other Tort (specify) O TAX FORECLOSURE Other Real Property: ._.-.- . . . (specify) i OTHER MATTERS —: _ ..:: ': ___—'.:::::.:.: '::::::::...: .: .. .::.:-'.:::::, SPECIAL PROCEEDINGS Certificate of Incorporation/Dissolution [see NOTE under Commerciaij 0 CPLR Article 75 (Arbitration) [see NOTE under Cornmerc a ] Emergency Medical Treatment O CPLR Article 78 (Body or Officer) :0 Hebeas Corpus O Election Law ,:0 Local Court Appeal 0 MHLAdicle 9.60 (Kendra's Law) Mechanic's Lien O MHLArticle 10 (Sex Offender Confinement-Initial) :0 Name Change O MHL Article 10 (Sex Offender Confinement-Review) :,0 Pistol Permit Revocation Hearing 0 MHL Article 81 (Guardianship) O Other Mental Hygiene: .0 Sale or Finance of Religious/Not-for-Profit Property (specify) Other: (specify) 0 Other Special Proceeding: STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated, YES NO Has a summons and complaintor summons w/noticebeen filed? 8 0 If yes, date filed: 06/28/2017 Has a summons and complaintor summons w/noticebeen served? 8 0 If yes, date served:_07/03/2017 07/03/2017 Is this being action/proceeding post-judgment? filed 0 () If yesjudgment date 1 of 4 FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM INDEX Index NO. #: EF2017-0115 EF2017-0115 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018 NATURE OFýÇÇlplAÜNTERVENTION . Chepk ONE box only ÃND enteradditional informatioJi)vher in'dicatdd. o Infant's Cornprornise o Note of Issue and/or of Readiness Certificate o Noticeof Medical, Dental,or Podiatric Malpractice Date IssueJoined: o Noticeof Motion ReliefSought: Motionto CancelLP an Discontinuethe Action ReturnDate: o Noticeof Petition Relief Sought: Return Date: o Orderto Show Cause Relief Sought: Return Date: o OtherEx Parte Application ReliefSought o Poor PersonApplication o Request for Preliminary Conference X ResidentialMortgage ForeclosureSettlernent Conference o Writof Habeas Corpus o Other(specifyt ' ' '' .' LISI 'any rota!et tinilyCourt cascsr i actions. For Mnatrunotiial actions, include any related crl'mtnaI and/jr . '':, -, ..; I If nOnC,Iea'yeblaIllc If additiOnal SpaCCiS required, COmpletCand attaCh the RJI Adderidunx . .. . .Cas Case ('.asc e i hide3/Case do. court ud e pf_assigned) to Instant Relationship ,Relationship Case . .........._......_.............. ..... . . .......----___.__..... .. _...___________. .. . ....- . . . ..........-... ........_..... . -. .. ------ tf additional space Is required, complete and attiich the RJI Addendum. Far Pa(Ice WithOutan attOrney CheCk"UnReP" bOXAND enter Party addieSS, PhOnenumber and e mail addreSSin "AttOinceyS" n i PaOe, -; --,-::-. Parties: . Attorneys: Issue Un- Listpartiesincaptionindiaandindicate atforneys' '' . partyrole(s) Provide name, firm name, businessaddress,phone number and email addressol of attorneys at) Joined Insurance Carriests Rep - * 3rd-party (58 defendant; ' plaintift) .' ' thai have appearedin the ease, tbsthavcappcarcdlathccase. ' ' '..' D//Ix{)- (Y/N): ,''American Advisors Group ROSICKI.ROSICKI & ASSOCIATES, P.C YES FirmName 0 26HARVESTERAVENUE BATAVIA sty . O NO 14020 .0 f ]; kola Pr:mary 1, ' I'iamlil1' Street address City State Zip Plaintitr '; RoleOfany) Secondary ,Plainnll' ' Plaintiff . Phone585-815.0288Fat 585-815-0299 e-mailattorneyconf@roswki com - -.........__._- ..... . .. ... ...... -..... -- . _..........._.. .. . .... . . .... . . DALEVANETTENASHEIRATLAWAND DALEVANErrhN ASHEIRATLAWANDNEXTOFKINOFROGER VANETTEN NENTOFKIN OFROGERVANETTENA/K/A .' A/K/AROGER D VANETTENA/K/ARODGER VA ROGERD.VANETTENA/K/A RODGERVA LastName FirstNanw LastName O NO ,OiVO FirmName DALEVANETTINASHETRATLAWAND . NEXTOFKIN OFROGERVANETTENA/K/A LOOP460.CROSSVILLE 55GARRISON , TN38555 ROGERD.VANETTENA/K/ARODGERVA Street address City State Zip FirstName Role Primary oI 1 . ' I DOUGLASVANETTENASHElHAT LAWAND DOUGLA$VANETTENASHEIRATLAWANDNEXTOFKINOFROGER VAN P itIES p NEXTOFKIN OFROGERVANETTENA/K/A i ETTENA/K/AROGER D VANETTENA'K/ARODGERVA ROGERD,VANFTTENA/K/ARODGERVA LastName FirstName LastName O NO FirmName DOUGLASVANETTENASHEIRATi'tT LAWAND I I NEXTOFKIN OFROGERVANETTENA/K/A 342MAGNOLIARD, RF.IDSVlLLE . GA30453 ROGERD.VANETTENA/K/A RODGERVA Sticetaddress City State Zip FirstName Role Primary Defendant Phone rax e-mail Role(ifany): Secondary Defendmat MILLER,SHARONM. MILLER,SHARONM LastName LastName FirstName 1 MILLER,SHARONM. FirmName 0 140 ienmc IVnmc FirstName I Il 64SHEFFIELD PrimaryRole RD, ITHACA,NY 14850 i Defendant address Street City State Zip Role(if any): Secondar3 I Deicndant Phone Fas e-n1ail T' NEWYORKSTATEDEPARTMENT OF NEWYORKSTATEDEPARTMENT OFTAXATION& FINANCE TAXATION& ia FINANCE LastName FirstName j last Name FirmName i O NO NEWYORKSTATEDEPAHTMENTOF I]I]I TAXATION4 FINANCE 350MAINST,STE300A.HUFFALO, NY 14202 FirstName Street address City State Zip PrimaryRole Defendang ' Role(if any): Secondary Phone Fax e-mait Defeadaot Defendant 2 of 4 FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM INDEXIndex NO. #: EF2017-0115 EF2017-0115 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018 ...-........ ........ ................--.............. -....................-----.... ...............................___................ .. .....................--.....-........_... PEOPLEOFTHESTATEOFNEWYORKC/O | PEOPLEOFTHESTATEOFNEWYORKC/OITHACAC[TYCOURT ITHACACITYCOURT LastName FirstName O YES LastName FirmName O NO :ONO PEOPLEOFTHESTATEOFNEWYORKC/O ITHACACITYCOURT 118E CLINTONSTREET. ITHACA,NY 14850 FirstName Streetaddress City State Zip PrimaryRole ',Defendant Role(if any): Secondary Phone Fax e-mail Defsndsni REGINABANFIELDASHEIRATLAWAND = REGINABANFIELDASHEIRATLAWANDNEXTOFKINOFROGER VANETTEN I ; NEXTOFKIN OFROGERVANETTENAfK/A i A/K/AROGERD.VANETTENA/K/ARODGERVAN O YES ! ROGERD.VANETTENA/K/A RODGERVAN LastName FirstName LastName O NO FirmName REGINABANFIELDASHEIRATLAWAND l NEXTOFKIN OFROGERVANETTENA/K/A 174OLD$TAGERD, GROTON,NY 13073 I ROGERD.VANETTENA/K/ARODGERVAN Streetaddress City State Zip FirstName PrimaryRole ; Defendant Phone Fax e-mad Role(if any): Secondary Defendant SUPPORTCOLLECTIONUNITO/B/O SUPPORTCOLLECTIONUNITO/B/OSHARONM.MlLLER SHARONM. MILLER LastName FirstName LastName FirmName O NO ,'0 $UPPORT COLLECTIONUNITO/B/0 I I SHARONM. MILLER CSEU420WESTSTATE ITHACA,N STREET, Y 14850 ."v'Y FirstName ! Streetaddress City State Zip PrimaryRole ; Defendant Role(if any): Phone Fax e-mail '! DefendantSecondary SUPPORTCOLLECTIONUNITO/B/OTRACY SUPPOKI' SUPPORTCOLLECTIONUNITOiB/OTRACYL EISTICE L EISTICE LastName FirstName LastName FirmName 0 NO SUPPORT COLLECTIONUNITO/B/OTRACY . I I: L EISTICE CSEU-320 WESTSTATE ITHACA,NY 14850 STRE£T, FirstName Streetaddress City State Zip PrimaryRo[c ; Defendant Role(if any): Secondary Phone Fax e-mail Defendans TABATHAVANETTENMONAHANASHEIR TABATHAVANETTENMONAHANASHEIRATLAWANDNEXTOFKINOFROGER ATLAWANDNEXTOFKIN OFROGERVAN VANETTENA K/AROGER D.VANETTENA/K/AR O y) | ETTENA/K/A ROGERD.VANETTENA/K/AR LastName FirstName LastName i0 NO FirmName . TABATHAVANETTENMONAHAN ASHEIR I I . ATLAWANDNEXTOFKIN OFROGERVAN 420DOUGLAS NY 14867 RD, NEWFIELD, i ETTENA/K/AROGERD.VANETTENA/K/AR Streetaddress City State Zip FirstName Role Primary '.Dct'endant | Defendant Phone Fax e-mail Role(if any): Secondary Defendent ....................... .. .~-_____....-..---- ..... ..._.._.._...._____..... ., TANYAPARSONS ASHEIRATLAWAND TANYAPARSONSASHElRATLAWANDNEXTOFKINOFROGER VANETTEN NEXTOFKIN OFROGERVANETTENA/K/A AIKiAROGERD.VANETTENA/K/ARODGERVANE ROGERD.VANETTENA/K/ARODGERVANE LastName FirstName LastName 0 NO Name . TANYAPARSONS ASHEIRATLAWAND l NEXTOFKIN OFROGERVANETTENA/K/A 525WARDBLVDW, NEWFIELD, NY 14867 ROGERD.VANETTENA/K/ARODGERVANE . Streetaddress City State Zip FirstName PrimaryRole . Defendant Phone Fax e-mad Role(ifany): Secondary Defendant TOMPKINSCOUNTYDEPARTMENT OF TOMPKINSCOUNTYDEPARTMENTOF SOCIALSERVICES SOCIALSERVICES LastName FirstName LasEName iVame FirmName O NO .:0 ' TOMPKINSCOUNTYDEPARTMENT OF I I SOCIALSERVICES 320WMARTINLUTHERKINGJR/STATESTREET, ITHACA.NY 14830 FirstName Streetaddress City State Zip PrimaryRole Defendan1 Role(ifany): Secondary Phone Fax e-mail Defendant 3 of 4 Cl2018-00676 INDEX Index NO. #: EF2017-0115 FILED: TOMPKINS COUNTY CLERK 01/11/2018 01:23 PM EF2017-0115 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/11/2018 TRINITYVANETTENMONAHANASHEIRAT TRINITYVANETTENMONAHANASHElRATLAWANDNEXTOFKINOFROGER LAWANDNEXTOFKIN OFROGERVAN . VANETTENAM/AROGER D.VANETTENA/K/AR 0 YES VAN' ETTENA/K/A ROGERD.VANETTENA/K/A R LastName FirstName LastName 0 NO FirmName TRINITYVANETTENMONAHANASHEIRAT .! II Kfh' OFROGERVAN LAWANDNEXTOFKIN 525WARDBLVDW, NEWFIELD , NY14867 ETTENanus ROGERD.VANETTENA/K/A8 Streetaddress City State Zip FirstName PrimaryRote Defendant Phone Fax e-mail Role(if any) Secondary Defendant UNITEDSTATESOFAMERICAO/B/O OFAMERICAO/B/OSECRETARY UNITEDSTATES OFHOUSING & URBAN OE' SECRETARYOFHOUSINGar URBAN i DliVELOPN1EN1' DEVELOPMENT ,OYES DEVELOPMENT Lastkame FirstName LastName 0 NO FirmName (N UNITEDSTATESOFAMERICAO/B/O I I SECRETARY OFHOUSING& URBrhh' URBAN 271CADMANPLAZA,7THFLOOR,BROOKLYN,NY 11201 DEVELOPMENT Streetaddress City State Zip FirstName ; Role Primary Defendant Phone Fax e-mail Role(if any): Secondary i Defendant .___._...... .. . . ._... ...._____....... ............. . ..._....... ...... ... .._.. ....___............... .. ._,....,-._........__________....... .,... . ....._._... .. ......-....__.____.--.---,--.--,-----·_ ...._.-,.............._________.__.. __ . VANETTEN(AKA) RODGERD.VANETTEN VANETTEN(AKA)RODGER D.VANETTEN ROGERD. (DECEASED), ROGERD. (DECEASED), LastName FirstName 'OYES Name FirmName 0 NO (n(O VANETTEN(AKA)RODGERD.VANETTEN I I ROGERD. (DECEASED), i 1954CODDINGTON ROAD.BROOKTONDALE,NY 14817 FirstName iVsme (xi&me Streetaddress City State Zip Rote Primary Defendant Role(if any): Secondary Phone Fox e-mail . Defendant I AFFIRM UNDER THE PENALTY OF PERJURY THKf, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE A JAND /AND BEEN'' ' HAVE BEEN NO RELATED ACTIONSOR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIA INTERVE 4 †f .Ix -VI BEEN FILED IN THIS ACTION OR P CEEj71NG. Dated Signature 5150669 Eric DeBarba ATTOR ATTORVF i'F V REGISTRATION REGISTRATIOVir NI JMIII'.R NllMBl.'k IsRI/V(T OR TYPF PRDil'I TVPF NAME 4 of 4