Preview
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
EXHIBIT U
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
RECENEB
SUPREME COURT OF THE STATE OF NEW YORK
.COUNTY OF ROCKLAND
------- ---------------------
gmcE C RT
-----------------X
PHADIA JEAN and VLADIMIR JEAN,
NOTICE OF MOTION
Plaintiffs,
- against -
TOWN OF ORANGETOWN, ORANGETOWN
POLICE DEPARTMENT, POLICE OPPICERS
DOE"
"JOHN One through Three and POLICE
DOE,"
OFFICER "JANE the names being fictitious
but intended to be the Police Officers of the
ORANGETOWN POLICE DEPARTMENT who
Engaged in illegal and negligent behavior against Index No. 033456/2016
Plaintiffs,
Defendants.
___..-___.-------------------------X
PLEASE TAKE NOTICE, that upon the annexed Affirmation of Richard S. Pakola,
Esq., attorney for the-defendants Town of Orangetown and the Orangetown Police Department
(the "Orangetown Defendants"), dated July 30, 2018, and upon allprior papers and proceedings,
the Orangetown Defendants will move this Court, before the Honorable Robert M. Berliner
J.S.C., at 1 South Main Street, New City, New York on August 10, 2018, or as soon thereafter as
the parties and counsel can be heard, for an Order:
Ordering"
A. Pursuant to CPLR § 2307, "So the enclosed Judicial Subpoea Duces
Tecum that requires the South Nyack Justice Court to produce:
(1) Certified copies of any and allbench warrants issued by the South
Nyack Justice Court regarding Jewel Russell-Otero, a/k/a Jewel
Russell, unknown date of birth.
(2) Certified copies of any document reflecting the last known address
of, or any other address associated with, the defendant Jewell
Russell-Otero, a/k/a Jewell Russell.
- 1 -
al. - 031
Phadia Jean, et al. v. Orangetown, et
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
(3) A copy of any photograph, if any exists, of the defendant Jewell
Russell-Otero, a/k/a Jewell Russell This request includes but is
"rap"
not limited to any sheet associated with the defendant Jewell
Russell-Otero, a/k/a Jewell Russell, with the understanding that all
information will be redacted with the exception of the name of the
defendant, the addresses associated with the defendant, and the
photograph of the defendant.
B. For such other and further relief as the Court deems just and proper,
PLEASE TAKE FURTHER NOTICE, that pursuant to CPLR § 2214 [b], answering
papers, if any, must be served upon the attorney for Petitioner on or before the return date of this
motion.
Dated: July 30, 2018
New City, New York
ROBERT V. MAGRINO, ESQ.
Town of Orangetown Town Attorney's Office
26 Orangeburg Road
Orangeburg, New York 10962
(845) 359-5100
FAX: (845) 359-2715
RICHARD S. PAKOLÃ, ESQ.
Counsel for the Orangetown Defendants
TO: Village of South Nyack Justice Court
282 South Broadway
South Nyack, NY 10960
Valerie J. Crown, Esq.
Valerie Crown, P.C.
151 North Main Street, 4th Floor
New City, NY 10956
.
- 2 -
al - 032
Phadia Jean, et al. v. Orangetown, et .
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ROCKLAND
____ ----------X
PHADIA JEAN and VLADIMIR JEAN,
- AFFIRMATION IN
Plaintiffs, SUPPORT OF MOTION
FOR SO ORDERED
- against - SUBPOENA DUCES
TECUM FOR VILLAGE
TOWN OF ORANGETOWN, ORANGETOWN OF SOUTH NYACK
POLICE DEPARTMENT, POLICE OFFICERS JUSTICE COURT
DOE"
"JOHN One through Three and POLICE DOCUMENTS
DOE,"
OFFICER "JANE the names being fictitious
but intended to be the Police Officers of the
ORANGETOWN POLICE DEPARTMENT who
Engaged in illegal and negligent behavior against Index No. 033456/2016
Plaintiffs,
Defendants.
---..---..______ .---------------------------------------X
RICHARD S. PAKOLA, ESQ., an attomey duly licensed to practice law in the Courts of
the State of New York, pursuant to CPLR § 2106 and under penalty of perjury, affirms as
follows:
1. I am a Deputy Town Attorney with the Town Attorney's Office of the Town of
Orangetown, counsel for the Defendants Town of Orangetown and Orangetown Police
Department, in the above captioned matter.
2. I am familiar with the facts, circumstances and proceedings herein and submit this
Affirmation in Support of the reliefrequested in the annexed Notice of Motion.
3. This motion requests that this Honorable Court, pursuant to CPLR § 2307, "So
Order"
the enclosed Subpoena Duces Tecum, which seeks production of certain records of the
Village of South Nyack Justice Court.
- 1 -
Phadia et al. v. et al . - 033
Jean, Orangetown,
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
Plaintiffs'
4 The allegations of complaint relate to a warrant sweep conducted by
the County ofRockland Sheriff's Department.
Plaintiffs'
5. One of the residences targeted by the warrant sweep was apartment at 2
Buckley Street, Central Nyack, New York. Plaintiff, who was not the subject of the bench
warrant, brings this lawsuit based upon the incidents relating to the attempt to execute the bench
warrant. She claims that her wrist was twisted by an officer, but aside from that, there was no
other physical contact. Also, at no point in time was she placed under arrest, and by her own
testimony, the entire interaction with the officers lasted only about 30 minutes.
6. As stated above, the warrant sweep was conducted by the County of Rockland,
not the Town of Orangetown.
7. Police Officer Dan Ryan of the Orangetown Police Department took part in the
attempt to execute the bench warrant, along with three officers from the County of Rockland
Sheriff's Department, but neither Police Officer Ryan nor any other employee of the Town of
Orangetown took any part in the planning of the warrant sweep or in selecting the target
locations, which tasks were accomplished by County personnel.
8. The underlying bench warrant was issued out of the Village of South Nyack
Justice Court, not the Orangetown Justice Court, and related to a defendant by the name of Jewel
Russell-Otero, a/k/a Jewel Russell, then before that Court.
9. Upon information and belief, County personnel selected Ms. Russell's lastknown
address, 2 Buckley Street, Central Nyack, New Yorlç as an appropriate location to search for her
whereabouts.
10. For whatever reasons, despite being informed in our Discovery Response of
January 2018 that the warrant sweep was planned and executed by the County of Rochnd, and
- 2 -
et al. - 034
Phadia Jean, et al. v. Orangetown,
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
that three of the four officers present at the incident were County employees, P½tif Fs have not
named the County of Rockland or the County of Rocldand Sheriff's Departraent, or any County
employees, in this lawsuit, and at this time are probably barred from doing so beause the
Plaintiffs have not timely filed a notice of claim against the County.
11. The Orangetown Defendants have no intention of impleading the County of
Rockland or County of Rockland SherijTs Department.
12. At this time, because the Town was not involved in the issuing of the bench
warrant or the planning of the warrant sweep, the Town does not have copies of relevant
documents necessary for the adequate defense of the Orangetown Defendants.
13. It issubmitted that the Village of South Nyack Justice Court case file on Ms.
Jewell Russell-Otero will contain discoverable and relevant information, such as the bench
warrant that the officers were attempting to execute on the day in question, as well as other
sheet"
documents reflecting addresses associated with Ms. Russell-Otero. If there is a "rap
present in the file,we request a copy of the rap sheet, as well, but consent to the redaction of all
portions of the rap sheet with the exception of the name of the defendant, addresses associated
with the defendant, and the photograph of the defendant. Plaintiff Phadia Jean has testified in
her deposition that the officers had a photograph of someone and were telling her that she looked
like the photograph. For this reason, we request that the photograph in the rap sheet not be
redacted and that any other photographs in the case file also be provided by the South Nyack
Justice Court.
14. We submit that the requested documents would be probative and relevant to the
issue of the good faith of the participating officers in the execution of an ostensibly valid bench
- 3 -
al. - 035
Phadia Jean, et al. v. Orangetown, et
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
warrant, as well as to the issue of whether qualified immunity should apply to any officer
participating in the execution of said bench warrant.
Ordered"
15. Absent a "So Subpoena Duces Tecum, the Crañgetown Defendants will
be unable to obtain the items requested.
16. No prior application has been made for the relief requested herein.
WHEREFORE, itis respectfully requested that the relief requested in the Orangetown
Defendants'
Notice of Motion be granted in itsentirety and for such other and further relief as
this Court deems just and proper.
Dated: July 30, 2018
Orangeburg, New York
RICHARD S. PAKOLA, BSQ. .
Counsel for the Orangetown Defendants
_4.
al. - 036
Phadia Jean, et al. v. Orangetown, et
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ROCKLAND
------------------ X
PHADIA JEAN and VLADIMIR JEAN,
Plaintiffs,
- against - SUBPOEANA DUCES
TECUM
TOWN OF ORANGETOWN, ORANGETOWN
POLICE DEPARTMENT, POLICE OFFICERS
DOE"
"JOHN One through Three and POLICE
DOE,"
OFFICER "JANE the names being fictitious . Index No. 33456/2016
but intended to be the Police Officers of the
ORANGETOWN POLICE DEPARTMENT who
Engaged in illegal and negligent behavior against
Plaintiffs,
Defendants.
---------------------------------------X
THE PEOPLE OF THE STATE OF NEW YORK
TO: Village of South Nyack Justice Court
282 South Broadway
South Nyack, New York 10960
TAKE NOTICE THAT allbusiness and excuses being laid aside, you are hereby
directed to produce to this Court before the Hon. Robert M. Berliner, located at 1 South Main
Street, New City, New York, either by personal delivery, express overnight delivery or regular
mail, such that they are received in hand no later than 10:00 AM on or before the of
, 2018, the following documents:
(1) Certified copies of any and allbench warrants issued by the South Nyack
Justice Court regarding Jewel Russell-Otero, a/k/a Jewel Russell, unknown
date of birth.
(2) Certified copies of any document reflecting the last known address of, or any
other address associated with, the defendant Jewell Russell-Otero, a/k/a Jewell
Russell.
A of if of the defendant Jewell Russell-
(3) copy any photograph, any exists,
.Otero, a/k/a Jewell Russell. This request includes but is not limited to any
"rap"
sheet associated with the defendant Jewell Russell-Otero, a/k/a Jewell
Russell, with the understed+ng that all information will be redacted with the
Phadia et al. v. et al. - 037
Jean, Orangetown,
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
exception of the name of the defendant, the addresses associated with the
defendant, and the photograph of the defendant
The circumstances or reasons that support disclosure of the subpoenaed documents in this
matter are: Plaintiffs have filed the above-captioned suit against the Orangetown Defendants,
relating to a County of Rockland warrant sweep and the execution of a South Nyack Justice
Court bench warrant issued for the defendant Jewell Russen, a/k/a Jewel Russell-Otero.
Failure to comply with this subpoena is punishable as a contempt of court and shall make
you liable to the person on whose behalf this subpoena was issued for a penalty not to exceed
one hundred and fifty($150) dollars and all damages sustained by reason of your failure to
comply.
DATED: July 30, 2018
Orangeburg, New York
ROBERT V. MAGRINO
Town Attorney
Town of Orangetown Town Attorney's Office
26 Orangeburg Road
Orangeburg, New York 10962
(845) 359-5100, ext. 2251
Fax: (845) 359-2715
BY: RICHARD S. PAKOLA, ESQ.
Deputy Town Attorney
SO ORDERED:
HON. ROBERT M. BERI1NER, J.S.C.
- 2 -
Phadia et al. v. et al. - 038
Jean, Orangetown,
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
Divestiture to Superior Court (170 CPL)
STATE OF NEW YORK
COUNTY OF Rockland South Nyack Village Court
Hon. Dennis E.A. Lynch
THE PEOPLE OF THE STATE OF NEW YORK
- ORDERED Hold forGrand Jury on
/ f
Divestiture After Indictment/SCI Notice
-VS-
Indictment/SCI#:
Jewel Russell-Otero Date Transmitted: 09/26/2018
LOCAL COURT INFORMÁTION
Docket#: 13100056 CC#: Arraign date: 11/13/2017
DEFENDANT INFORMATION F )0(10068D(
Sex Race DOB NYSID NUMBER
10/10/2013 SN
Arrest Date Agency Defense Counsel & Phone #, ifknown:
Defandant's Address: 5 Addison Boyce Dr B Bail Posted: 5 0O
New City,NY 10956 Bail Amount $:
Bail Type(C/B):
CHARGES HELD FOR ACTION OF THE GRAND JURY:
VTL 0401 01A- REGISTRATN VIO . VTL 1180 OD - Speeding 40/30
. VTL 0511 01A- AGG UNLIC OPER3 PL 165.40 - CPSP 5
The following are beingforwarded to h+1and County Court .
(Please check allthatapply)
Complaint Wail Papers _License forwarded to Albany
Felony (raaadatóry)
09/26/2018
___Supporting Deposition (mandatory) . _Securing Order Date Forwarded:
UCS 540 Notice of Appearance .
501 Card UTT's _(number enclosed)
ArrestReport DCJS Report
Other (DWI refusal,appearance etc.
ticket,
Submit thisform along with originalsof theappropr ate papers as provided in CPL 180.70(1) to theaddress of theappropriate court
. South Nyack Village Court Court Name
90 Depot Place - StreetAddress
(Firehouse)
South Nyack, NY 10960 City,State,Zip:
Until such time thatthese papers are received,thisaction isdeemed to be still
pending in thelocalcriminal court.
Please notifythis courtifan indictment has not been filedwithin 90 ()days, or a request has not been made toreturn
thiscase to thelower criminalcourt.
DATED: September 26, 2018
By: /
SIGNATURE
f2lf/ Ž./ B& C
TITLE
D Lt1F GWr
Phadia et al. v. et al. - 039
Jean, Orangetown,
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
0 PARTMaa . APPEARANCE TICKET ,m , .
m
20 0WQ6DW ;.Y SOUTH F4YACK, C!Y , ? .0-·96 8 C. P. L 150.10
NAIWÈ-
LAST r-•.. tiltSI INITIAl-
YOUAREHEREBY NOTIFIEDTOAPPEARPERSONALLYIN THE
.. AQDJ(ES5
STREET . -
$C . N f AC KVM.AM COURE GRAND VfEW G C . OR
crifoRTow sw ZIP 91D(iPOT F1.ACE R010vI2 ROAD
-¾)( SOUhi NYACK 10960 GRAND VI W, NY IGNO
DENTI.FICATION
$HOWN DATEGFBIRTH ...
ON (DATE) Abi / YRC AT - M
TO ANSWER A CHARGEOF .
PRE-ARRAIGNMENT BAIL
AN OFFENSE Q
PRE-ARRANGEMEN BAl 5 FlXED IN THE FOLLOWING
COMMITTED IN CITY/TOWN'-/ILLAGs pF
. AMOUNT , L .--' 1 RECElPTWHEREOF
NEW YORK
IS,HEREBYACKNOWLEDGED AND THE PERSONARRESTEDHEREINIS .. . D
RELEASEDFROM CUSTODYTO APPEARAS HEREIN DIRECTED,
OWE DAR OF AT M
IN VIOLATION OF SECTION SUB-DIVISIOÑ
• OF THE LAW OF THE STATEOF NEW YORK,
ISSUED.THI5' ,Ì
DAY OF , YR
AUTHORIZED ] b.. . i.
OFFICER
DEPT.& .
RANK -
UPONYOUR
FAtLURÜO ASHEREÎsI
APPEAR WILLBEFORFErrED.
THEBAILPOSTED
DIRECTEÒ, OFFICER'S
SIGNATURE OFFICER'S IFICATIONNo-
p. EMSPOSETION:
UPON YOUR FAILURE TO APPEAR AS ABOVE DI CTE ,.A CR MI , AL SUMMO S OR A WARRA T FOR YOU ARREST M -Y. BE ISSU .D.
. NOTICE You are entitled to receive a supporting
deposition furt
er exp aining
e ed you request su
arges provi supportingeposition wit
in thi ays
! fmm the date you are directed to appear in court as set forth on.this appearance ticket. Do you request a supporting depo.sition?
O YES NO
_..._.. ___._____......._. . . .__.. ___ ...._____-.______
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
SOUTH NYACK - GRAND VIEW POUCE BAIL RECElPT - CPL 520.15 Sub. 2
. 282 SOUTH BROADWAY 3512
SOUTH NYACK NY 10960
-.g-)
... CASH BAIL $. DATE: Î iOO
Defendant: ... v. bOB: Phone
Bail Posted By: Phone:
Employed By Address:
Next Appearance Date
THE POSTING OF CASH BAIL IS WITH THE ASSURANCE OF THE OWNER OF SAID BAIL THAT THE DEFENDANT WILL APPEAR AS DRECTED 9
AT ALL TIMES ATREQUIRED BY THE· COURT. ANY VIOLATION OF THIS AGREEMENT MAY ' CAUSE THE CASH BAIL TO BE FORFETTEDAND A
WARRANT TO SE ISSUED SECURilfG TH11DEFEhIDANT. ... i .
.
Signed: Dated:
Officer. Dated: .
O WILLIAMSON
LAWBOOKCO.VCTOR Y14564
. .
.
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016
NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021
APPEARANCE TICKET
C. P. L 150.10 Q 6 Rj
LAST
NAME · FIR5T INMAL YOUAREHEREBY NOTiFIEDTOAPPEARPERSONALLY1NTHE
ADDRESS
STREET
CITY
ORTOWN STAT ZP
5HOWN "
D NTIFICAMON DATE
OFB1RTH '
ON (DATE) YR AT M
PRE-ARRAIGNMENT BAIL
AN OFFENSE
PRE-ARRANGEMENTBAIL IS FIXED IN THE FOLLOWING
COÙiMITTED IN CITY/TOWNMLLA OF Q c_Jr
AMOUNT RECElPTWHEREOF
NEW YORK
15HEREBYACKNOWLEDGED AND THE PERSONARRESTEDHEREINIS Q
ON THE C3 DATE OF a
t. ,YR ! AT O M.0 M
RELEASEDFROM CUSTODYTO APPEARAS HEREINDIRECTED.
IN ViOLATION OF SECTION 5 u - L. / c SUB-DMSION
OF THE LAW OF THE STATEOF NEW YORK, O
O
155UEDTHIS Ci DAY OF O , YR \3
AUTHORIZED
OFRCER [ ., q ...,
f O
UPONYOUR TOAPPEAR
FAIU.1RE ASHEREIN THEBAILPOSTED
DIRECTED, FORFEITED.
WILLBE OFFICE SIGNATURE OFRCER'SIDENTlRCAnONNO-
NOME. DISPOSITION:
oR R 5
NOTICE: Yo re toArec v u or gÛÎp lÎonfr .Ÿp@5!Ê; ge v Are u Rot d p n t i
frorn the date you are directed to appear in court as set forth on this appearance tid XIX 1998 CHEV GY
--- - |f the Court denies your plea, you will be notified by mail to appear in the Court
PlateNumber Reg.State Registration Expires
noted on the front of this ticket,
GEiX9177 NY 7/26/2014
THE PERSON DESCRiBED ABOVE IS CHARGED AS FOLLOWS SECTION A - PLEA OF GUILTY
Time Dateaf Offense INVlOLATiONDF
1:15 AM 10/10/2013 . NYS V AND T LAW To the Court fisted on the other side of this ticket:
. SectionSubSedian Tr infMisd Felony MPH MPHZone . . . .
37512AB3 . ® O O res|ding at
have been charged witl) t
@ldSD($sf%íb61tibdon the other side of this ticket. I
DescriptionofViolation
receipt of tlie waming printed In bold type on the other side of this ticket
aclG-,Gwladge
REAR SIDE WINDOWS NON/TRANSPAREliT US DOT# and f waive arraignment in open court and the aid of an Attomey. | plead GUlLTY to
the offense as charged and request that this charge be disposed of and a f|ne or
CDL Veh Bus Haz Ma penalty fixed by the court.
O O O (optional):
Additionally, ; make the following staternent of s:;w.den
Placeof Occurrence Hwy.No. Loc.Code
S/B SOUTH BROADWAY 4426
C/TN Rame County HwyType NCt0/ORI
SOUTH NYACK, VILLAGE OF - 4426 ROCKLAND 5 04326
AFFIRMEDUNDERPENALTY OFPERJuRY . OffAssign
DateAffirmed All statements are made under penalty of perjury:
10/10/2013
ArrestTe Date: Slgned:
1 - PA ROL ____
Badge/Shield
- SECTION B - PLEA OF NOT GU[LTY
(Officer'sBignature) S7
Onice s LastName FirstName . M.I. .The following notice appiles to you if the officer did not issue you a supporting
. GALLAGHER PATRICK deposition with your ticket.
NOTICE: YOU ARE ENTITLED TO RECEiVE A SUPPORTING
DEPOSITION FURTHER EXPLAINING THE CHARGES PROVIDED
YOU REQUEST SUCH SUPPORT1NG DEPOSITION WITH1N THIRTY
(30) DAYS FROM THE DATE YOU ARE DIRECTED TO RESPOND TO
RadarO|ficersSignature THE COURT NOTED ON THE OTHER S[DE OF THIS APPEARANCE
THIS MATTER IS SCHEDULED TO BE HANDLED ON THE APPEARANCE DATE BELOW
---
Yes No
SOUTH NYACK VlLLAGE COURT SUPPORTING DEPOSITION PROVIDED WHEN THIS TICKET WAS
Address ISSUED? NO @ SPEEDING (Gen 101) O
282 SOUTH BROADWAY
GENERAL (Gen 101A)
City . a State Zip
SOUTH NYACK NY 10960 Signature
RETURN BY MAIL BEFORE OR 1NPERSON ON: Date Time .
1D/21/2013 5:30 PM
MUST APPEAR IN PERSON .
A PLEA OF GUILTY TO THIS CHARGE IS
EQUlVALENT TO A CONVICTION AFTER TRIAL. IF
City State Zip Code
YOU ARE CONVICTED, NOT ONLY WILL YOU BE
NOTE: Mail th|s NOT GUILTY Plea within 48 hours. The court will notify
LIABLE TO A PENALTY, BUT IN ADDITION YOUR you by mrst Class Mau of your appearance date.
LICENSE TO DRIVE A MOTOR VEHICLE OR .APPLICANTS UNDER 18 YEARS OF AGE
MOTORCYCLE, AND YOUR CERTIFICATE OF MuST SUBM[T NAN[EAND ADDRESS OF PARENT OR GUARDIAN BELOW.
REGISTRATION, IF ANY, ARE SUBJECT TO
SUSPENSION AND REVOCATION AS PRESCRIBED Nameof Parent or Guardian
BY LAW- Address __
Cosictionmay subject you to a mandatory surcharge and/or Driver Re-pmelb!!!ª/
City State Zip Code
Assessment as prescribed by taw.
FAILURE TO ANSWER THIS TICKET WILL RESULT IN THE SUSPENSION OF
Your failure to respond may result in a warrant for your arrest or suspension of your driver's
YOUR LICENSEAND A DEFAULT JUDGEMENT AGAINST YOU.
license and/or a default judgement against you.
UTD-1.7(4/02)
R|lllin |||!ln!!!!lilli
WKS
Preview
FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 EXHIBIT U FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 RECENEB SUPREME COURT OF THE STATE OF NEW YORK .COUNTY OF ROCKLAND ------- --------------------- gmcE C RT -----------------X PHADIA JEAN and VLADIMIR JEAN, NOTICE OF MOTION Plaintiffs, - against - TOWN OF ORANGETOWN, ORANGETOWN POLICE DEPARTMENT, POLICE OPPICERS DOE" "JOHN One through Three and POLICE DOE," OFFICER "JANE the names being fictitious but intended to be the Police Officers of the ORANGETOWN POLICE DEPARTMENT who Engaged in illegal and negligent behavior against Index No. 033456/2016 Plaintiffs, Defendants. ___..-___.-------------------------X PLEASE TAKE NOTICE, that upon the annexed Affirmation of Richard S. Pakola, Esq., attorney for the-defendants Town of Orangetown and the Orangetown Police Department (the "Orangetown Defendants"), dated July 30, 2018, and upon allprior papers and proceedings, the Orangetown Defendants will move this Court, before the Honorable Robert M. Berliner J.S.C., at 1 South Main Street, New City, New York on August 10, 2018, or as soon thereafter as the parties and counsel can be heard, for an Order: Ordering" A. Pursuant to CPLR § 2307, "So the enclosed Judicial Subpoea Duces Tecum that requires the South Nyack Justice Court to produce: (1) Certified copies of any and allbench warrants issued by the South Nyack Justice Court regarding Jewel Russell-Otero, a/k/a Jewel Russell, unknown date of birth. (2) Certified copies of any document reflecting the last known address of, or any other address associated with, the defendant Jewell Russell-Otero, a/k/a Jewell Russell. - 1 - al. - 031 Phadia Jean, et al. v. Orangetown, et FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 (3) A copy of any photograph, if any exists, of the defendant Jewell Russell-Otero, a/k/a Jewell Russell This request includes but is "rap" not limited to any sheet associated with the defendant Jewell Russell-Otero, a/k/a Jewell Russell, with the understanding that all information will be redacted with the exception of the name of the defendant, the addresses associated with the defendant, and the photograph of the defendant. B. For such other and further relief as the Court deems just and proper, PLEASE TAKE FURTHER NOTICE, that pursuant to CPLR § 2214 [b], answering papers, if any, must be served upon the attorney for Petitioner on or before the return date of this motion. Dated: July 30, 2018 New City, New York ROBERT V. MAGRINO, ESQ. Town of Orangetown Town Attorney's Office 26 Orangeburg Road Orangeburg, New York 10962 (845) 359-5100 FAX: (845) 359-2715 RICHARD S. PAKOLÃ, ESQ. Counsel for the Orangetown Defendants TO: Village of South Nyack Justice Court 282 South Broadway South Nyack, NY 10960 Valerie J. Crown, Esq. Valerie Crown, P.C. 151 North Main Street, 4th Floor New City, NY 10956 . - 2 - al - 032 Phadia Jean, et al. v. Orangetown, et . FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ROCKLAND ____ ----------X PHADIA JEAN and VLADIMIR JEAN, - AFFIRMATION IN Plaintiffs, SUPPORT OF MOTION FOR SO ORDERED - against - SUBPOENA DUCES TECUM FOR VILLAGE TOWN OF ORANGETOWN, ORANGETOWN OF SOUTH NYACK POLICE DEPARTMENT, POLICE OFFICERS JUSTICE COURT DOE" "JOHN One through Three and POLICE DOCUMENTS DOE," OFFICER "JANE the names being fictitious but intended to be the Police Officers of the ORANGETOWN POLICE DEPARTMENT who Engaged in illegal and negligent behavior against Index No. 033456/2016 Plaintiffs, Defendants. ---..---..______ .---------------------------------------X RICHARD S. PAKOLA, ESQ., an attomey duly licensed to practice law in the Courts of the State of New York, pursuant to CPLR § 2106 and under penalty of perjury, affirms as follows: 1. I am a Deputy Town Attorney with the Town Attorney's Office of the Town of Orangetown, counsel for the Defendants Town of Orangetown and Orangetown Police Department, in the above captioned matter. 2. I am familiar with the facts, circumstances and proceedings herein and submit this Affirmation in Support of the reliefrequested in the annexed Notice of Motion. 3. This motion requests that this Honorable Court, pursuant to CPLR § 2307, "So Order" the enclosed Subpoena Duces Tecum, which seeks production of certain records of the Village of South Nyack Justice Court. - 1 - Phadia et al. v. et al . - 033 Jean, Orangetown, FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 Plaintiffs' 4 The allegations of complaint relate to a warrant sweep conducted by the County ofRockland Sheriff's Department. Plaintiffs' 5. One of the residences targeted by the warrant sweep was apartment at 2 Buckley Street, Central Nyack, New York. Plaintiff, who was not the subject of the bench warrant, brings this lawsuit based upon the incidents relating to the attempt to execute the bench warrant. She claims that her wrist was twisted by an officer, but aside from that, there was no other physical contact. Also, at no point in time was she placed under arrest, and by her own testimony, the entire interaction with the officers lasted only about 30 minutes. 6. As stated above, the warrant sweep was conducted by the County of Rockland, not the Town of Orangetown. 7. Police Officer Dan Ryan of the Orangetown Police Department took part in the attempt to execute the bench warrant, along with three officers from the County of Rockland Sheriff's Department, but neither Police Officer Ryan nor any other employee of the Town of Orangetown took any part in the planning of the warrant sweep or in selecting the target locations, which tasks were accomplished by County personnel. 8. The underlying bench warrant was issued out of the Village of South Nyack Justice Court, not the Orangetown Justice Court, and related to a defendant by the name of Jewel Russell-Otero, a/k/a Jewel Russell, then before that Court. 9. Upon information and belief, County personnel selected Ms. Russell's lastknown address, 2 Buckley Street, Central Nyack, New Yorlç as an appropriate location to search for her whereabouts. 10. For whatever reasons, despite being informed in our Discovery Response of January 2018 that the warrant sweep was planned and executed by the County of Rochnd, and - 2 - et al. - 034 Phadia Jean, et al. v. Orangetown, FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 that three of the four officers present at the incident were County employees, P½tif Fs have not named the County of Rockland or the County of Rocldand Sheriff's Departraent, or any County employees, in this lawsuit, and at this time are probably barred from doing so beause the Plaintiffs have not timely filed a notice of claim against the County. 11. The Orangetown Defendants have no intention of impleading the County of Rockland or County of Rockland SherijTs Department. 12. At this time, because the Town was not involved in the issuing of the bench warrant or the planning of the warrant sweep, the Town does not have copies of relevant documents necessary for the adequate defense of the Orangetown Defendants. 13. It issubmitted that the Village of South Nyack Justice Court case file on Ms. Jewell Russell-Otero will contain discoverable and relevant information, such as the bench warrant that the officers were attempting to execute on the day in question, as well as other sheet" documents reflecting addresses associated with Ms. Russell-Otero. If there is a "rap present in the file,we request a copy of the rap sheet, as well, but consent to the redaction of all portions of the rap sheet with the exception of the name of the defendant, addresses associated with the defendant, and the photograph of the defendant. Plaintiff Phadia Jean has testified in her deposition that the officers had a photograph of someone and were telling her that she looked like the photograph. For this reason, we request that the photograph in the rap sheet not be redacted and that any other photographs in the case file also be provided by the South Nyack Justice Court. 14. We submit that the requested documents would be probative and relevant to the issue of the good faith of the participating officers in the execution of an ostensibly valid bench - 3 - al. - 035 Phadia Jean, et al. v. Orangetown, et FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 warrant, as well as to the issue of whether qualified immunity should apply to any officer participating in the execution of said bench warrant. Ordered" 15. Absent a "So Subpoena Duces Tecum, the Crañgetown Defendants will be unable to obtain the items requested. 16. No prior application has been made for the relief requested herein. WHEREFORE, itis respectfully requested that the relief requested in the Orangetown Defendants' Notice of Motion be granted in itsentirety and for such other and further relief as this Court deems just and proper. Dated: July 30, 2018 Orangeburg, New York RICHARD S. PAKOLA, BSQ. . Counsel for the Orangetown Defendants _4. al. - 036 Phadia Jean, et al. v. Orangetown, et FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ROCKLAND ------------------ X PHADIA JEAN and VLADIMIR JEAN, Plaintiffs, - against - SUBPOEANA DUCES TECUM TOWN OF ORANGETOWN, ORANGETOWN POLICE DEPARTMENT, POLICE OFFICERS DOE" "JOHN One through Three and POLICE DOE," OFFICER "JANE the names being fictitious . Index No. 33456/2016 but intended to be the Police Officers of the ORANGETOWN POLICE DEPARTMENT who Engaged in illegal and negligent behavior against Plaintiffs, Defendants. ---------------------------------------X THE PEOPLE OF THE STATE OF NEW YORK TO: Village of South Nyack Justice Court 282 South Broadway South Nyack, New York 10960 TAKE NOTICE THAT allbusiness and excuses being laid aside, you are hereby directed to produce to this Court before the Hon. Robert M. Berliner, located at 1 South Main Street, New City, New York, either by personal delivery, express overnight delivery or regular mail, such that they are received in hand no later than 10:00 AM on or before the of , 2018, the following documents: (1) Certified copies of any and allbench warrants issued by the South Nyack Justice Court regarding Jewel Russell-Otero, a/k/a Jewel Russell, unknown date of birth. (2) Certified copies of any document reflecting the last known address of, or any other address associated with, the defendant Jewell Russell-Otero, a/k/a Jewell Russell. A of if of the defendant Jewell Russell- (3) copy any photograph, any exists, .Otero, a/k/a Jewell Russell. This request includes but is not limited to any "rap" sheet associated with the defendant Jewell Russell-Otero, a/k/a Jewell Russell, with the understed+ng that all information will be redacted with the Phadia et al. v. et al. - 037 Jean, Orangetown, FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 exception of the name of the defendant, the addresses associated with the defendant, and the photograph of the defendant The circumstances or reasons that support disclosure of the subpoenaed documents in this matter are: Plaintiffs have filed the above-captioned suit against the Orangetown Defendants, relating to a County of Rockland warrant sweep and the execution of a South Nyack Justice Court bench warrant issued for the defendant Jewell Russen, a/k/a Jewel Russell-Otero. Failure to comply with this subpoena is punishable as a contempt of court and shall make you liable to the person on whose behalf this subpoena was issued for a penalty not to exceed one hundred and fifty($150) dollars and all damages sustained by reason of your failure to comply. DATED: July 30, 2018 Orangeburg, New York ROBERT V. MAGRINO Town Attorney Town of Orangetown Town Attorney's Office 26 Orangeburg Road Orangeburg, New York 10962 (845) 359-5100, ext. 2251 Fax: (845) 359-2715 BY: RICHARD S. PAKOLA, ESQ. Deputy Town Attorney SO ORDERED: HON. ROBERT M. BERI1NER, J.S.C. - 2 - Phadia et al. v. et al. - 038 Jean, Orangetown, FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 Divestiture to Superior Court (170 CPL) STATE OF NEW YORK COUNTY OF Rockland South Nyack Village Court Hon. Dennis E.A. Lynch THE PEOPLE OF THE STATE OF NEW YORK - ORDERED Hold forGrand Jury on / f Divestiture After Indictment/SCI Notice -VS- Indictment/SCI#: Jewel Russell-Otero Date Transmitted: 09/26/2018 LOCAL COURT INFORMÁTION Docket#: 13100056 CC#: Arraign date: 11/13/2017 DEFENDANT INFORMATION F )0(10068D( Sex Race DOB NYSID NUMBER 10/10/2013 SN Arrest Date Agency Defense Counsel & Phone #, ifknown: Defandant's Address: 5 Addison Boyce Dr B Bail Posted: 5 0O New City,NY 10956 Bail Amount $: Bail Type(C/B): CHARGES HELD FOR ACTION OF THE GRAND JURY: VTL 0401 01A- REGISTRATN VIO . VTL 1180 OD - Speeding 40/30 . VTL 0511 01A- AGG UNLIC OPER3 PL 165.40 - CPSP 5 The following are beingforwarded to h+1and County Court . (Please check allthatapply) Complaint Wail Papers _License forwarded to Albany Felony (raaadatóry) 09/26/2018 ___Supporting Deposition (mandatory) . _Securing Order Date Forwarded: UCS 540 Notice of Appearance . 501 Card UTT's _(number enclosed) ArrestReport DCJS Report Other (DWI refusal,appearance etc. ticket, Submit thisform along with originalsof theappropr ate papers as provided in CPL 180.70(1) to theaddress of theappropriate court . South Nyack Village Court Court Name 90 Depot Place - StreetAddress (Firehouse) South Nyack, NY 10960 City,State,Zip: Until such time thatthese papers are received,thisaction isdeemed to be still pending in thelocalcriminal court. Please notifythis courtifan indictment has not been filedwithin 90 ()days, or a request has not been made toreturn thiscase to thelower criminalcourt. DATED: September 26, 2018 By: / SIGNATURE f2lf/ Ž./ B& C TITLE D Lt1F GWr Phadia et al. v. et al. - 039 Jean, Orangetown, FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 0 PARTMaa . APPEARANCE TICKET ,m , . m 20 0WQ6DW ;.Y SOUTH F4YACK, C!Y , ? .0-·96 8 C. P. L 150.10 NAIWÈ- LAST r-•.. tiltSI INITIAl- YOUAREHEREBY NOTIFIEDTOAPPEARPERSONALLYIN THE .. AQDJ(ES5 STREET . - $C . N f AC KVM.AM COURE GRAND VfEW G C . OR crifoRTow sw ZIP 91D(iPOT F1.ACE R010vI2 ROAD -¾)( SOUhi NYACK 10960 GRAND VI W, NY IGNO DENTI.FICATION $HOWN DATEGFBIRTH ... ON (DATE) Abi / YRC AT - M TO ANSWER A CHARGEOF . PRE-ARRAIGNMENT BAIL AN OFFENSE Q PRE-ARRANGEMEN BAl 5 FlXED IN THE FOLLOWING COMMITTED IN CITY/TOWN'-/ILLAGs pF . AMOUNT , L .--' 1 RECElPTWHEREOF NEW YORK IS,HEREBYACKNOWLEDGED AND THE PERSONARRESTEDHEREINIS .. . D RELEASEDFROM CUSTODYTO APPEARAS HEREIN DIRECTED, OWE DAR OF AT M IN VIOLATION OF SECTION SUB-DIVISIOÑ • OF THE LAW OF THE STATEOF NEW YORK, ISSUED.THI5' ,Ì DAY OF , YR AUTHORIZED ] b.. . i. OFFICER DEPT.& . RANK - UPONYOUR FAtLURÜO ASHEREÎsI APPEAR WILLBEFORFErrED. THEBAILPOSTED DIRECTEÒ, OFFICER'S SIGNATURE OFFICER'S IFICATIONNo- p. EMSPOSETION: UPON YOUR FAILURE TO APPEAR AS ABOVE DI CTE ,.A CR MI , AL SUMMO S OR A WARRA T FOR YOU ARREST M -Y. BE ISSU .D. . NOTICE You are entitled to receive a supporting deposition furt er exp aining e ed you request su arges provi supportingeposition wit in thi ays ! fmm the date you are directed to appear in court as set forth on.this appearance ticket. Do you request a supporting depo.sition? O YES NO _..._.. ___._____......._. . . .__.. ___ ...._____-.______ FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 SOUTH NYACK - GRAND VIEW POUCE BAIL RECElPT - CPL 520.15 Sub. 2 . 282 SOUTH BROADWAY 3512 SOUTH NYACK NY 10960 -.g-) ... CASH BAIL $. DATE: Î iOO Defendant: ... v. bOB: Phone Bail Posted By: Phone: Employed By Address: Next Appearance Date THE POSTING OF CASH BAIL IS WITH THE ASSURANCE OF THE OWNER OF SAID BAIL THAT THE DEFENDANT WILL APPEAR AS DRECTED 9 AT ALL TIMES ATREQUIRED BY THE· COURT. ANY VIOLATION OF THIS AGREEMENT MAY ' CAUSE THE CASH BAIL TO BE FORFETTEDAND A WARRANT TO SE ISSUED SECURilfG TH11DEFEhIDANT. ... i . . Signed: Dated: Officer. Dated: . O WILLIAMSON LAWBOOKCO.VCTOR Y14564 . . . FILED: ROCKLAND COUNTY CLERK 12/20/2021 09:41 PM INDEX NO. 033456/2016 NYSCEF DOC. NO. 137 RECEIVED NYSCEF: 12/20/2021 APPEARANCE TICKET C. P. L 150.10 Q 6 Rj LAST NAME · FIR5T INMAL YOUAREHEREBY NOTiFIEDTOAPPEARPERSONALLY1NTHE ADDRESS STREET CITY ORTOWN STAT ZP 5HOWN " D NTIFICAMON DATE OFB1RTH ' ON (DATE) YR AT M PRE-ARRAIGNMENT BAIL AN OFFENSE PRE-ARRANGEMENTBAIL IS FIXED IN THE FOLLOWING COÙiMITTED IN CITY/TOWNMLLA OF Q c_Jr AMOUNT RECElPTWHEREOF NEW YORK 15HEREBYACKNOWLEDGED AND THE PERSONARRESTEDHEREINIS Q ON THE C3 DATE OF a t. ,YR ! AT O M.0 M RELEASEDFROM CUSTODYTO APPEARAS HEREINDIRECTED. IN ViOLATION OF SECTION 5 u - L. / c SUB-DMSION OF THE LAW OF THE STATEOF NEW YORK, O O 155UEDTHIS Ci DAY OF O , YR \3 AUTHORIZED OFRCER [ ., q ..., f O UPONYOUR TOAPPEAR FAIU.1RE ASHEREIN THEBAILPOSTED DIRECTED, FORFEITED. WILLBE OFFICE SIGNATURE OFRCER'SIDENTlRCAnONNO- NOME. DISPOSITION: oR R 5 NOTICE: Yo re toArec v u or gÛÎp lÎonfr .Ÿp@5!Ê; ge v Are u Rot d p n t i frorn the date you are directed to appear in court as set forth on this appearance tid XIX 1998 CHEV GY --- - |f the Court denies your plea, you will be notified by mail to appear in the Court PlateNumber Reg.State Registration Expires noted on the front of this ticket, GEiX9177 NY 7/26/2014 THE PERSON DESCRiBED ABOVE IS CHARGED AS FOLLOWS SECTION A - PLEA OF GUILTY Time Dateaf Offense INVlOLATiONDF 1:15 AM 10/10/2013 . NYS V AND T LAW To the Court fisted on the other side of this ticket: . SectionSubSedian Tr infMisd Felony MPH MPHZone . . . . 37512AB3 . ® O O res|ding at have been charged witl) t @ldSD($sf%íb61tibdon the other side of this ticket. I DescriptionofViolation receipt of tlie waming printed In bold type on the other side of this ticket aclG-,Gwladge REAR SIDE WINDOWS NON/TRANSPAREliT US DOT# and f waive arraignment in open court and the aid of an Attomey. | plead GUlLTY to the offense as charged and request that this charge be disposed of and a f|ne or CDL Veh Bus Haz Ma penalty fixed by the court. O O O (optional): Additionally, ; make the following staternent of s:;w.den Placeof Occurrence Hwy.No. Loc.Code S/B SOUTH BROADWAY 4426 C/TN Rame County HwyType NCt0/ORI SOUTH NYACK, VILLAGE OF - 4426 ROCKLAND 5 04326 AFFIRMEDUNDERPENALTY OFPERJuRY . OffAssign DateAffirmed All statements are made under penalty of perjury: 10/10/2013 ArrestTe Date: Slgned: 1 - PA ROL ____ Badge/Shield - SECTION B - PLEA OF NOT GU[LTY (Officer'sBignature) S7 Onice s LastName FirstName . M.I. .The following notice appiles to you if the officer did not issue you a supporting . GALLAGHER PATRICK deposition with your ticket. NOTICE: YOU ARE ENTITLED TO RECEiVE A SUPPORTING DEPOSITION FURTHER EXPLAINING THE CHARGES PROVIDED YOU REQUEST SUCH SUPPORT1NG DEPOSITION WITH1N THIRTY (30) DAYS FROM THE DATE YOU ARE DIRECTED TO RESPOND TO RadarO|ficersSignature THE COURT NOTED ON THE OTHER S[DE OF THIS APPEARANCE THIS MATTER IS SCHEDULED TO BE HANDLED ON THE APPEARANCE DATE BELOW --- Yes No SOUTH NYACK VlLLAGE COURT SUPPORTING DEPOSITION PROVIDED WHEN THIS TICKET WAS Address ISSUED? NO @ SPEEDING (Gen 101) O 282 SOUTH BROADWAY GENERAL (Gen 101A) City . a State Zip SOUTH NYACK NY 10960 Signature RETURN BY MAIL BEFORE OR 1NPERSON ON: Date Time . 1D/21/2013 5:30 PM MUST APPEAR IN PERSON . A PLEA OF GUILTY TO THIS CHARGE IS EQUlVALENT TO A CONVICTION AFTER TRIAL. IF City State Zip Code YOU ARE CONVICTED, NOT ONLY WILL YOU BE NOTE: Mail th|s NOT GUILTY Plea within 48 hours. The court will notify LIABLE TO A PENALTY, BUT IN ADDITION YOUR you by mrst Class Mau of your appearance date. LICENSE TO DRIVE A MOTOR VEHICLE OR .APPLICANTS UNDER 18 YEARS OF AGE MOTORCYCLE, AND YOUR CERTIFICATE OF MuST SUBM[T NAN[EAND ADDRESS OF PARENT OR GUARDIAN BELOW. REGISTRATION, IF ANY, ARE SUBJECT TO SUSPENSION AND REVOCATION AS PRESCRIBED Nameof Parent or Guardian BY LAW- Address __ Cosictionmay subject you to a mandatory surcharge and/or Driver Re-pmelb!!!ª/ City State Zip Code Assessment as prescribed by taw. FAILURE TO ANSWER THIS TICKET WILL RESULT IN THE SUSPENSION OF Your failure to respond may result in a warrant for your arrest or suspension of your driver's YOUR LICENSEAND A DEFAULT JUDGEMENT AGAINST YOU. license and/or a default judgement against you. UTD-1.7(4/02) R|lllin |||!ln!!!!lilli WKS