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SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS
x
WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK, +
Plaintiff,
-against-
NINA DAYEN DO PC
Defendant(s) a RMATION
NON-PAYMENT
x
The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New
York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon
information and belief.
This affirmation is based upon a review of the file which is maintained by the Workers' Compensation
Board in its regular course of business.
| am familiar with the status of payment in this matter. The award/penalty/assessment/demand for
deposit of security made against the defendant(s) in the amount of $42,000.00 is in default, as more
than thirty days have elapsed since the demand upon the defendant(s) herein for payment. No payment
has been received nor has the aforesaid security been deposited in compliance with said demand to
date, except the sum of $0.00, leaving due and payble the sum of $42,000.00.
Dated: _5Sth_ day of _ August. 2013
S/
James R. McGinn, Esq.
Judgment Unit
C-45.45E 1/2009SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS
x
WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK, +
Plaintiff,
-against-
NINA DAYEN DO PC :
Defendant(s) : ACIRMATION
REGULARITY
x
The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New
York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon
information and belief.
This affirmation is based upon a review of the file which is maintained by the Workers' Compensation
Board in its regular course of business.
The Workers' Compensation Board of the State of New York, in accordance with the provisions of the
Workers’ Compensation Law, has made an assessment/award in the sum of $42,000.00, against the
defendant(s). Attached hereto and made a part hereof are certified copies of the Notice of Decision and
Award, and/or a certified copy of the demand for deposit of security, and/or a certified copy of the chair's
order imposing, and the demand for payment of, assessments imposed by the chair pursuant to
subdivision five of section fifty-two and/or one hundred thirty one of the Workers’ Compensation Law, as
required for filing of judgment per Workers' Compensation Law, Section 26 and/or 219. Appeals before
the Board have been exhausted.
No payment of award has been made except $0.00, leaving $42,000.00 due and payable.
WHEREFORE, it is respectfully requested that judgment be entered against the Defendant(s) herein in
the sum stated as remaining due and payable.
Dated: _ 5th day of _ August 2013.
Sf
James R. McGinn, Esq.
Judgment Unit
C-45.1E 6/2007NINA DAYEN DO PC
1775 E13TH ST APT 4H
BROOKLYN NY 11229-1932
DATE: 08/05/2013
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
JUDGMENT UNIT PEOPLE WK DISABLITIESWWTHOUT
328 STATE STREET DISCRIMINATION.
SCHENECTADY, NY 12305-2318
866-298-7830
WCB EMPLOYER # 2703488
VIER #. 50-61003
FEIN/SS # DBE
Itis hereby certified that this is a true
and correct copy of the original as filed
with the Workers’ Compensation Board
Sf
James R. McGi
FINAL NOTICE * Judgment Unit
Certified on__08/05/13
, Esq.
|fotal Balance Due
Item Description Dates Accident Date] Balance Due
jzo12wo038762 Failure to Carry Workers! Comp Ins 06/30/2012-01/28/2013 $42,000.00
$42,000.00)
Non-Compliance
* If payment is not received immediately, judgment will be filed and the employer is subject to seizure
of assets, both business and personal, without further notice from the Board.
In order to insure prompt credit of your payment, complete the following with the
Date, Number and Amount of your check and return it, along with your payment to:
WORKERS' COMPENSATION BOARD.
FINANCE OFFICE
328 STATE STREET, SCHENECTADY, NY 12305-2318
Please detach and return bottom portion with your payment.
MAKE CHECKS PAYABLE TO “UNINSURED EMPLOYERS FUND”.
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
Employer | NINA DAYEN DO PC WCB Employer # | 2703488
Customer ID # 1719082
Check Date
Check
Check # Amount
C-45.37 5/2004
Page 1 of 2Non-Compliance
Item Description Dates Accident Date | Balance Due
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
Mail payment along with this form to:
WORKERS' COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET
SCHENECTADY, NY 12305-2318
C-45.37 5/2004 Page 2 of 2SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS
x
WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK, : JUDGMENT
Plaintiff,
-against- : EMP# 2703488
> JUDF : 1287954
NINA DAYEN DO PC :
Defendant(s) > INDEX#
FILING DT:
x
By order of the Chair of the Workers' Compensation Board of the State of New York, demand for the
payment of the sum of $42,000.00, representing Awards and Penalties having been made against the
above captioned Defendant(s), after due notice, having defaulted in payment thereof, except the sum of
$0.00 leaving $42,000.00 due and payable.
NOW, upon the certified copies of notices attached hereto, and upon motion of the General Counsel of
the Workers' Compensation Board of the State of New York, attorney for Plaintiff, pursuant to Section
26 of the Workers' Compensation Law of the State of New York providing for entry of judgment by the
County Clerk in event of such default, it is ADJUDGED, that the Plaintiff, Workers' Compensation Board
of the State of New York, 328 State Street, Schenectady, NY 12305 does recover from the
above-captioned Defendant(s), whose last known address(es) are; 1775 E 13TH ST APT 4H,
BROOKLYN, NY 11229-1932, respectively; the sum of $42,000.00, and the Plaintiff have execution
therefore.
Judgment signed this: day of
Clerk
James R. McGinn, Esq.
Attorney for Plaintiff
Workers' Compensation Board
328 State St.
Schenectady, NY 12305
C-45 6/2007
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SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS x WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK, + Plaintiff, -against- NINA DAYEN DO PC Defendant(s) a RMATION NON-PAYMENT x The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon information and belief. This affirmation is based upon a review of the file which is maintained by the Workers' Compensation Board in its regular course of business. | am familiar with the status of payment in this matter. The award/penalty/assessment/demand for deposit of security made against the defendant(s) in the amount of $42,000.00 is in default, as more than thirty days have elapsed since the demand upon the defendant(s) herein for payment. No payment has been received nor has the aforesaid security been deposited in compliance with said demand to date, except the sum of $0.00, leaving due and payble the sum of $42,000.00. Dated: _5Sth_ day of _ August. 2013 S/ James R. McGinn, Esq. Judgment Unit C-45.45E 1/2009SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS x WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK, + Plaintiff, -against- NINA DAYEN DO PC : Defendant(s) : ACIRMATION REGULARITY x The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon information and belief. This affirmation is based upon a review of the file which is maintained by the Workers' Compensation Board in its regular course of business. The Workers' Compensation Board of the State of New York, in accordance with the provisions of the Workers’ Compensation Law, has made an assessment/award in the sum of $42,000.00, against the defendant(s). Attached hereto and made a part hereof are certified copies of the Notice of Decision and Award, and/or a certified copy of the demand for deposit of security, and/or a certified copy of the chair's order imposing, and the demand for payment of, assessments imposed by the chair pursuant to subdivision five of section fifty-two and/or one hundred thirty one of the Workers’ Compensation Law, as required for filing of judgment per Workers' Compensation Law, Section 26 and/or 219. Appeals before the Board have been exhausted. No payment of award has been made except $0.00, leaving $42,000.00 due and payable. WHEREFORE, it is respectfully requested that judgment be entered against the Defendant(s) herein in the sum stated as remaining due and payable. Dated: _ 5th day of _ August 2013. Sf James R. McGinn, Esq. Judgment Unit C-45.1E 6/2007NINA DAYEN DO PC 1775 E13TH ST APT 4H BROOKLYN NY 11229-1932 DATE: 08/05/2013 STATE OF NEW YORK WORKERS' COMPENSATION BOARD JUDGMENT UNIT PEOPLE WK DISABLITIESWWTHOUT 328 STATE STREET DISCRIMINATION. SCHENECTADY, NY 12305-2318 866-298-7830 WCB EMPLOYER # 2703488 VIER #. 50-61003 FEIN/SS # DBE Itis hereby certified that this is a true and correct copy of the original as filed with the Workers’ Compensation Board Sf James R. McGi FINAL NOTICE * Judgment Unit Certified on__08/05/13 , Esq. |fotal Balance Due Item Description Dates Accident Date] Balance Due jzo12wo038762 Failure to Carry Workers! Comp Ins 06/30/2012-01/28/2013 $42,000.00 $42,000.00) Non-Compliance * If payment is not received immediately, judgment will be filed and the employer is subject to seizure of assets, both business and personal, without further notice from the Board. In order to insure prompt credit of your payment, complete the following with the Date, Number and Amount of your check and return it, along with your payment to: WORKERS' COMPENSATION BOARD. FINANCE OFFICE 328 STATE STREET, SCHENECTADY, NY 12305-2318 Please detach and return bottom portion with your payment. MAKE CHECKS PAYABLE TO “UNINSURED EMPLOYERS FUND”. PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. Employer | NINA DAYEN DO PC WCB Employer # | 2703488 Customer ID # 1719082 Check Date Check Check # Amount C-45.37 5/2004 Page 1 of 2Non-Compliance Item Description Dates Accident Date | Balance Due MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". Mail payment along with this form to: WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET SCHENECTADY, NY 12305-2318 C-45.37 5/2004 Page 2 of 2SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS x WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK, : JUDGMENT Plaintiff, -against- : EMP# 2703488 > JUDF : 1287954 NINA DAYEN DO PC : Defendant(s) > INDEX# FILING DT: x By order of the Chair of the Workers' Compensation Board of the State of New York, demand for the payment of the sum of $42,000.00, representing Awards and Penalties having been made against the above captioned Defendant(s), after due notice, having defaulted in payment thereof, except the sum of $0.00 leaving $42,000.00 due and payable. NOW, upon the certified copies of notices attached hereto, and upon motion of the General Counsel of the Workers' Compensation Board of the State of New York, attorney for Plaintiff, pursuant to Section 26 of the Workers' Compensation Law of the State of New York providing for entry of judgment by the County Clerk in event of such default, it is ADJUDGED, that the Plaintiff, Workers' Compensation Board of the State of New York, 328 State Street, Schenectady, NY 12305 does recover from the above-captioned Defendant(s), whose last known address(es) are; 1775 E 13TH ST APT 4H, BROOKLYN, NY 11229-1932, respectively; the sum of $42,000.00, and the Plaintiff have execution therefore. Judgment signed this: day of Clerk James R. McGinn, Esq. Attorney for Plaintiff Workers' Compensation Board 328 State St. Schenectady, NY 12305 C-45 6/2007