Preview
FILED: YATES COUNTY CLERK 12/01/2020 10:26 AM INDEX NO. 2020-5102
NYSCEF DOC. NO. 16 RECEIVED NYSCEF: 12/01/2020
REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,)
Yates Supreme COURT, COUNTY OF Yates
Index No: 2020-5102 Date Index Issued: 09/14/2020 For Court Use Only:
CAA t. IAS EntryDate
Nadine Khouzam Chawla as Executrix of the Estateof Magda G. Daoud
Judge Assigned
-against- Plaintiff(s)/Petitioner(s)
Irilert& SailorsMemorie! Hospital ofYates County, Finger Lakes Health Foundatian. Inc.,Stephanie AchillesMD,
Maria Y. Battle-Q !d;;!cyMD, Jane Doe RJIFiled Date
Defendant(s)/Respondent(s)
COMMERCIAL MATRIMONIAL
O Contested
O BusinessEntity (includes corporations, par+narchine LLCs,LLps,etC.)
NOTE: If there are children under the age of 18, complete and attach the
Contract MATRIMONDALRJRAddendum (UCS-840M).
O Insurance(where insurance company is a party, except =±!trat!ent .
For UncontestedMatnmonial actions, use the UncontestedDivorce RJi(UD-13).
O UCC(includes sales and negotiable in:;t=r.er.:s)
O Other Commercial(specify):
| TORTS
NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d),
complete and attach the COMMERCIALDEVISIONRJRADDENDUM (UCS-840C). Asbestos
O Child Victims Act
REAL PROPERTY: Specify how many properties the application includes: .
Eny----M .
(specify):
O Condemnation Medical,Dental, or Podiatric Malpractice
O O Residential
Mortgage Foreclosure(specify): O Commercial O Motor Vehicle
Property Address: O Products Liability (specify):
O Other Negligence(specify):
NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner-
occupied residential property or owner-occupiedcondominium, complete andOther Fioiessional Malpractice (specify):
attach the FORECLDSURERJRADDENDUM (UCS-840F). Other Tort (specify):
O
Tax Certiorari - Section: Block: Lot:
Tax Foreclosure | SPECIAL PROCEEDINGS
Other Real Property (specify): O CPLRArticle 75 (Arbitration)
[see NOTE in COMMERCIALsection]
O
O CPLRArticle 78 (Body or Officer)
OTHER MATTERS
O Election Law
O Certificate of Incorporatior.‡!:::!-c'!:n
[see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder
O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law)
O HabeasCorpus O MHLArticle 10 (Sex Offender Confinamant-Initial)
O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review)
O Mechanic'sLien MHLArticle 81 (Guardianship)
O NameChange O Other Mental Hygiene (specify):
Pistol Permit nevocat!cn Hearing O Other Special Proceeding(specify):
O Saleor Financeof Religious/Not-for-ProfitProperty
O Other (specify):
STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated.
YES NO
Hasa summons and complaint or summonswith notice been filed? O 09/14/2020
If yes, date filed:
Hasa summons and complaint or summonswith notice been served? O 10/24/2020
If yes, date served:
Is this action/proceeding being filed post-judgment? O If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional !nfemet!cn where indicated.
O Infant's Compromise
O Extreme Risk ProtectionOrder Application
O Note of Issue/Certificateof Readiness
11/24/2020
Date Issuejoined:
Notice of Medical, Dental, or Podiatric Malpractice
Notice of Motion Relief Requested: Return Date:
O
Notice of Petition Relief Requested: Return Date:
O
Order to ShowCause Relief Requested: Return Date:
O
Other Ex ParteApplication Relief Requested:
O
O PoorPersonApplication
O Requestfor Preliminary Conference
O ResidentialMortgage Fuim.lusureSeM!ementConference
O Writ of HabeasCorpus
O Other (specify):
1 of 2
FILED: YATES COUNTY CLERK 12/01/2020 10:26 AM INDEX NO. 2020-5102
NYSCEF DOC. NO. 16 RECEIVED NYSCEF: 12/01/2020
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).
Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance
Un-
Rep List parties in same order as listed in the
For represented parties, provide attorney's name, firm name, address, phone
For each defendant,
For each defendant,
caption and indicate roles (e.g., plaintiff,
and email. For unrepresented parties, provide party's address, phone and
indicate if issue has
indicate insurance
defendant; 3rd party plaintiff, etc.)email. been joined. carrier, if applicable.
Name: Chawla, Nadine K.
☐ MICHAEL BROWN, Ziff Law Firm, 303 William Street ,
Elmira, NY 14902, mbrown@zifflaw.com ☒ YES ☐ NO
Role(s): Plaintiff/Petitioner
Name: Soldiers & Sailors Memorial
☐ Hospital of Yates County
RICHARD TUBIOLO, Hirsch & Tubiolo, P.C., 1000 Reynolds
Arcade Building 16 East Main St., Rochester, NY 14614, ☒ YES ☐ NO
unknown
Role(s): Defendant/Respondent (585) 546-2434, rtubiolo@hirschtubiololaw.com
Name: Finger Lakes Health
☐ Foundation, Inc.
RICHARD TUBIOLO, Hirsch & Tubiolo, P.C., 1000 Reynolds
Arcade Building 16 East Main St., Rochester, NY 14614, ☒ YES ☐ NO
unknown
Role(s): Defendant/Respondent (585) 546-2434, rtubiolo@hirschtubiololaw.com
Name: Achilles, Stephanie
☐ AARON DEPAOLO, O'Connor, O'Connor, Bresee & First,
P.C., 20 Corporate Woods Blvd. , Albany, NY 12211, 518- ☒ YES ☐ NO
unknown
Role(s): Defendant/Respondent 465-0400, depaolo@oobf.com
Name: Battle-Quidgley, Maria Y.
☐ MARGARET FOWLER, LEVENE, GOULDIN&THOMPSON, LLP,
PO BOX F1706 , BINGHAMTON, NY 13902, ☒ YES ☐ NO
unknown
Role(s): Defendant/Respondent mfowler@lgtlegal.com
Name: Doe, Jane
☐ RICHARD TUBIOLO, Hirsch & Tubiolo, P.C., 1000 Reynolds
Arcade Building 16 East Main St., Rochester, NY 14614, ☒ YES ☐ NO
unknown
Role(s): Defendant/Respondent (585) 546-2434, rtubiolo@hirschtubiololaw.com
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: 12/01/2020 MICHAEL DOUGLAS BROWN
Signature
5105440 MICHAEL DOUGLAS BROWN
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 2
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FILED: YATES COUNTY CLERK 12/01/2020 10:26 AM INDEX NO. 2020-5102 NYSCEF DOC. NO. 16 RECEIVED NYSCEF: 12/01/2020 REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,) Yates Supreme COURT, COUNTY OF Yates Index No: 2020-5102 Date Index Issued: 09/14/2020 For Court Use Only: CAA t. IAS EntryDate Nadine Khouzam Chawla as Executrix of the Estateof Magda G. Daoud Judge Assigned -against- Plaintiff(s)/Petitioner(s) Irilert& SailorsMemorie! Hospital ofYates County, Finger Lakes Health Foundatian. Inc.,Stephanie AchillesMD, Maria Y. Battle-Q !d;;!cyMD, Jane Doe RJIFiled Date Defendant(s)/Respondent(s) COMMERCIAL MATRIMONIAL O Contested O BusinessEntity (includes corporations, par+narchine LLCs,LLps,etC.) NOTE: If there are children under the age of 18, complete and attach the Contract MATRIMONDALRJRAddendum (UCS-840M). O Insurance(where insurance company is a party, except =±!trat!ent . For UncontestedMatnmonial actions, use the UncontestedDivorce RJi(UD-13). O UCC(includes sales and negotiable in:;t=r.er.:s) O Other Commercial(specify): | TORTS NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d), complete and attach the COMMERCIALDEVISIONRJRADDENDUM (UCS-840C). Asbestos O Child Victims Act REAL PROPERTY: Specify how many properties the application includes: . Eny----M . (specify): O Condemnation Medical,Dental, or Podiatric Malpractice O O Residential Mortgage Foreclosure(specify): O Commercial O Motor Vehicle Property Address: O Products Liability (specify): O Other Negligence(specify): NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner- occupied residential property or owner-occupiedcondominium, complete andOther Fioiessional Malpractice (specify): attach the FORECLDSURERJRADDENDUM (UCS-840F). Other Tort (specify): O Tax Certiorari - Section: Block: Lot: Tax Foreclosure | SPECIAL PROCEEDINGS Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection] O O CPLRArticle 78 (Body or Officer) OTHER MATTERS O Election Law O Certificate of Incorporatior.‡!:::!-c'!:n [see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law) O HabeasCorpus O MHLArticle 10 (Sex Offender Confinamant-Initial) O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review) O Mechanic'sLien MHLArticle 81 (Guardianship) O NameChange O Other Mental Hygiene (specify): Pistol Permit nevocat!cn Hearing O Other Special Proceeding(specify): O Saleor Financeof Religious/Not-for-ProfitProperty O Other (specify): STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated. YES NO Hasa summons and complaint or summonswith notice been filed? O 09/14/2020 If yes, date filed: Hasa summons and complaint or summonswith notice been served? O 10/24/2020 If yes, date served: Is this action/proceeding being filed post-judgment? O If yes, judgment date: NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional !nfemet!cn where indicated. O Infant's Compromise O Extreme Risk ProtectionOrder Application O Note of Issue/Certificateof Readiness 11/24/2020 Date Issuejoined: Notice of Medical, Dental, or Podiatric Malpractice Notice of Motion Relief Requested: Return Date: O Notice of Petition Relief Requested: Return Date: O Order to ShowCause Relief Requested: Return Date: O Other Ex ParteApplication Relief Requested: O O PoorPersonApplication O Requestfor Preliminary Conference O ResidentialMortgage Fuim.lusureSeM!ementConference O Writ of HabeasCorpus O Other (specify): 1 of 2 FILED: YATES COUNTY CLERK 12/01/2020 10:26 AM INDEX NO. 2020-5102 NYSCEF DOC. NO. 16 RECEIVED NYSCEF: 12/01/2020 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). Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Un- Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance defendant; 3rd party plaintiff, etc.)email. been joined. carrier, if applicable. Name: Chawla, Nadine K. ☐ MICHAEL BROWN, Ziff Law Firm, 303 William Street , Elmira, NY 14902, mbrown@zifflaw.com ☒ YES ☐ NO Role(s): Plaintiff/Petitioner Name: Soldiers & Sailors Memorial ☐ Hospital of Yates County RICHARD TUBIOLO, Hirsch & Tubiolo, P.C., 1000 Reynolds Arcade Building 16 East Main St., Rochester, NY 14614, ☒ YES ☐ NO unknown Role(s): Defendant/Respondent (585) 546-2434, rtubiolo@hirschtubiololaw.com Name: Finger Lakes Health ☐ Foundation, Inc. RICHARD TUBIOLO, Hirsch & Tubiolo, P.C., 1000 Reynolds Arcade Building 16 East Main St., Rochester, NY 14614, ☒ YES ☐ NO unknown Role(s): Defendant/Respondent (585) 546-2434, rtubiolo@hirschtubiololaw.com Name: Achilles, Stephanie ☐ AARON DEPAOLO, O'Connor, O'Connor, Bresee & First, P.C., 20 Corporate Woods Blvd. , Albany, NY 12211, 518- ☒ YES ☐ NO unknown Role(s): Defendant/Respondent 465-0400, depaolo@oobf.com Name: Battle-Quidgley, Maria Y. ☐ MARGARET FOWLER, LEVENE, GOULDIN&THOMPSON, LLP, PO BOX F1706 , BINGHAMTON, NY 13902, ☒ YES ☐ NO unknown Role(s): Defendant/Respondent mfowler@lgtlegal.com Name: Doe, Jane ☐ RICHARD TUBIOLO, Hirsch & Tubiolo, P.C., 1000 Reynolds Arcade Building 16 East Main St., Rochester, NY 14614, ☒ YES ☐ NO unknown Role(s): Defendant/Respondent (585) 546-2434, rtubiolo@hirschtubiololaw.com 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: 12/01/2020 MICHAEL DOUGLAS BROWN Signature 5105440 MICHAEL DOUGLAS BROWN Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 2