Preview
FILED: SUFFOLK COUNTY CLERK 12/07/2021 09:22 AM INDEX NO. 611178/2021
NYSCEF DOC. NO. 17 RECEIVED NYSCEF: 12/07/2021
REQUEST FOR JUDICIAL INTERVENTION UCS-840
(rev. 07/29/2019)
SUPREME COURT, COUNTY OF SUFFOLK
Index No: 611178/2021 Date Index Issued: June 11, 2021 For Court Use Only:
Date Index Issued:
CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. IAS Entry Date
NICHOLAS DASSLER,
Plaintiff(s)/Petitioner(s) Judge Assigned
-against-
DANIEL B. KREMEN AND GOLDEN HAWK LLC,
RJI Filed Date
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING Check only one box and specify where indicated.
COMMERICIAL MATRIMONIAL
Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) Contested
Contract NOTE: If there are children under the age of 18, complete and attach the
Insurance (where insurance company is a party, except arbitration) MATRIMONIAL RJI ADDENDUM (UCS-840M).
UCC (includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
Other Commercial (specify): TORTS
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), Asbestos
complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). Child Victims Act
REAL PROPERTY Specify how many properties the application includes: Environmental (specify):
Condemnation Medical, Dental or Podiatric Malpractice
Mortgage Foreclosure (specify): Residential Commercial Motor Vehicle
Property Address: Products Liability (specify):
NOTE: For Mortgage Foreclosure actions involving a one to four-family, Other Negligence (specify):
owner-occupied residential property or owner-occupied condominium, Other Professional Malpractice (specify):
complete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F). Other Tort (specify):
Tax Certiorari SPECIAL PROCEEDINGS
Tax Foreclosure CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section]
Other Real Property (specify): CPLR Article 78 (Body or Officer)
OTHER MATTERS Election Law
Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] Extreme Risk Protection Order
Emergency Medical Treatment MHL Article 9.60 (Kendra’s Law)
Habeas Corpus MHL Article 10 (Sex Offender Confinement-Initial)
Local Court Appeal Mechanic’s Lien Name Change MHL Article 10 (Sex Offender Confinement-Review)
Pistol Permit Revocation Hearing MHL Article 81 (Guardianship)
Sale or Finance of Religious/Not-for-Profit Property Other Mental Hygiene (specify):
Other (specify): Other Special Proceeding (specify):
STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated.
YES NO
Has a summons and complaint or summons with notice been filed? If yes, date filed: June 11, 2021
Has a summons and complaint or summons with notice been served? If yes, date served: August 25, 2021
Is this action/proceeding being filed post-judgment? If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated.
Infant’s Compromise
Extreme Risk Protection Order Application
Note of Issue/Certificate of Readiness
Notice of Medical, Dental or Podiatric Malpractice Date Issue Joined:
Notice of Motion Relief Requested: Summary Judgment Return Date: January 4, 2022
Notice of Petition Relief Requested: Return Date:
Order to Show Cause Relief Requested: Return Date:
Other Ex Parte Application Relief Requested:
Poor Person Application
Request for Preliminary Conference
Residential Mortgage Foreclosure Settlement Conference
Writ of Habeas Corpus
Other (specify):
1 of 2
FILED: SUFFOLK COUNTY CLERK 12/07/2021 09:22 AM INDEX NO. 611178/2021
NYSCEF DOC. NO. 17 RECEIVED NYSCEF: 12/07/2021
RELATED CASES List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank.
If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case
PARTIES For parties without an attorney, check the “Un-Rep” box and enter the party’s address, phone number and email in the space provided.
If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
Un- Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers
Rep List parties in same order as listed in the For represented parties, provide attorney’s name, firm name, address, phone and For each defendant, For each defendant,
caption and indicate roles (e.g., plaintiff, email. For unrepresented parties, provide party’s address, phone and email. indicate if issue has indicate insurance
defendant, 3rd party plaintiff, etc.) been joined. carrier, if applicable.
Name: NICHOLAS DASSLER Gary A. Pagliarello, Rosenberg & Gluck, LLP, 1176 Portion Rd.,
Holtsville, NY 11742 – (631) 451-7900 – gpagliarello@lilawyer.com YES NO
Role(s): PLAINTIFF
Name: DANIEL B. KREMEN Ann Eccher, Esq., Smith Mazure, P.C., 111 John Street, 20th Fl., National Indemnity
New York, New York 10038 – (516) 294-7325 YES NO
Role(s): DEFENDANT
Name: GOLDEN HAWK LLC Ann Eccher, Esq., Smith Mazure, P.C., 111 John Street, 20th Fl., National Indemnity
New York, New York 10038 – (516) 294-7325 YES NO
Role(s): DEFENDANT
Name:
YES NO
Role(s):
Name:
YES NO
Role(s):
Name:
YES NO
Role(s):
Name:
YES NO
Role(s):
Name:
YES NO
Role(s):
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS,
EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING.
Dated: December 6, 2021
Signature
2202588 Gary A. Pagliarello
Attorney Registration Number Print Name
2 of 2
Preview
FILED: SUFFOLK COUNTY CLERK 12/07/2021 09:22 AM INDEX NO. 611178/2021 NYSCEF DOC. NO. 17 RECEIVED NYSCEF: 12/07/2021 REQUEST FOR JUDICIAL INTERVENTION UCS-840 (rev. 07/29/2019) SUPREME COURT, COUNTY OF SUFFOLK Index No: 611178/2021 Date Index Issued: June 11, 2021 For Court Use Only: Date Index Issued: CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. IAS Entry Date NICHOLAS DASSLER, Plaintiff(s)/Petitioner(s) Judge Assigned -against- DANIEL B. KREMEN AND GOLDEN HAWK LLC, RJI Filed Date Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING Check only one box and specify where indicated. COMMERICIAL MATRIMONIAL Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) Contested Contract NOTE: If there are children under the age of 18, complete and attach the Insurance (where insurance company is a party, except arbitration) MATRIMONIAL RJI ADDENDUM (UCS-840M). UCC (includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13). Other Commercial (specify): TORTS NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), Asbestos complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). Child Victims Act REAL PROPERTY Specify how many properties the application includes: Environmental (specify): Condemnation Medical, Dental or Podiatric Malpractice Mortgage Foreclosure (specify): Residential Commercial Motor Vehicle Property Address: Products Liability (specify): NOTE: For Mortgage Foreclosure actions involving a one to four-family, Other Negligence (specify): owner-occupied residential property or owner-occupied condominium, Other Professional Malpractice (specify): complete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F). Other Tort (specify): Tax Certiorari SPECIAL PROCEEDINGS Tax Foreclosure CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section] Other Real Property (specify): CPLR Article 78 (Body or Officer) OTHER MATTERS Election Law Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] Extreme Risk Protection Order Emergency Medical Treatment MHL Article 9.60 (Kendra’s Law) Habeas Corpus MHL Article 10 (Sex Offender Confinement-Initial) Local Court Appeal Mechanic’s Lien Name Change MHL Article 10 (Sex Offender Confinement-Review) Pistol Permit Revocation Hearing MHL Article 81 (Guardianship) Sale or Finance of Religious/Not-for-Profit Property Other Mental Hygiene (specify): Other (specify): Other Special Proceeding (specify): STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated. YES NO Has a summons and complaint or summons with notice been filed? If yes, date filed: June 11, 2021 Has a summons and complaint or summons with notice been served? If yes, date served: August 25, 2021 Is this action/proceeding being filed post-judgment? If yes, judgment date: NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated. Infant’s Compromise Extreme Risk Protection Order Application Note of Issue/Certificate of Readiness Notice of Medical, Dental or Podiatric Malpractice Date Issue Joined: Notice of Motion Relief Requested: Summary Judgment Return Date: January 4, 2022 Notice of Petition Relief Requested: Return Date: Order to Show Cause Relief Requested: Return Date: Other Ex Parte Application Relief Requested: Poor Person Application Request for Preliminary Conference Residential Mortgage Foreclosure Settlement Conference Writ of Habeas Corpus Other (specify): 1 of 2 FILED: SUFFOLK COUNTY CLERK 12/07/2021 09:22 AM INDEX NO. 611178/2021 NYSCEF DOC. NO. 17 RECEIVED NYSCEF: 12/07/2021 RELATED CASES List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A). Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case PARTIES For parties without an attorney, check the “Un-Rep” box and enter the party’s address, phone number and email in the space provided. If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A). Un- Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers Rep List parties in same order as listed in the For represented parties, provide attorney’s name, firm name, address, phone and For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, email. For unrepresented parties, provide party’s address, phone and email. indicate if issue has indicate insurance defendant, 3rd party plaintiff, etc.) been joined. carrier, if applicable. Name: NICHOLAS DASSLER Gary A. Pagliarello, Rosenberg & Gluck, LLP, 1176 Portion Rd., Holtsville, NY 11742 – (631) 451-7900 – gpagliarello@lilawyer.com YES NO Role(s): PLAINTIFF Name: DANIEL B. KREMEN Ann Eccher, Esq., Smith Mazure, P.C., 111 John Street, 20th Fl., National Indemnity New York, New York 10038 – (516) 294-7325 YES NO Role(s): DEFENDANT Name: GOLDEN HAWK LLC Ann Eccher, Esq., Smith Mazure, P.C., 111 John Street, 20th Fl., National Indemnity New York, New York 10038 – (516) 294-7325 YES NO Role(s): DEFENDANT Name: YES NO Role(s): Name: YES NO Role(s): Name: YES NO Role(s): Name: YES NO Role(s): Name: YES NO Role(s): I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. Dated: December 6, 2021 Signature 2202588 Gary A. Pagliarello Attorney Registration Number Print Name 2 of 2