Preview
FILED: SCHENECTADY COUNTY CLERK 04/26/2022 12:11 PM INDEX NO. 2021-1129
NYSCEF DOC. NO. 8 RECEIVED NYSCEF: 04/26/2022
UCS-840
REQUEST FOR JUDICIAL INTERVENTION (rev. 07/29/2019)
SUPREME COURT, COUNTY OF SCHENECTADY 124217-01/MOS/
Index No: 2021-1129 Date Index Issued: 06/03/2021
For Court Use Only:
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
GEORGE SMITH,
Judge Assigned
Plaintiff(s)/Petitioner(s),
-against-
RJI Filed Date
NISKAYUNA OPERATING CO., LLC d/b/a PATHWAYS NURSING AND REHABILITATION CENTER, PATHWAYS NURSING AND REHABILITATION
CENTER, and “JOHN and/or JANE DOE(S) and ABC COMPANIES 1-10” whose names being unknown and fictitious,
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
Asbestos
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
Child Victims Act
complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C).
Environmental (specify):
REAL PROPERTY Specify how many properties the application includes:
Medical, Dental or Podiatric Malpractice
Condemnation
Motor Vehicle
Mortgage Foreclosure (specify): Residential Commercial
Products Liability (specify):
Property Address:
Other Negligence (specify):
PHL §2801-d claims and nursing home abuse,
NOTE: For Mortgage Foreclosure actions involving a one to four-family,
neglect, and mistreatment.
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
Tax Foreclosure SPECIAL PROCEEDINGS
Other Real Property (specify): CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section]
CPLR Article 78 (Body or Officer)
Election Law
OTHER MATTERS
Extreme Risk Protection Order
Certificate of Incorporation/Dissolution
[see NOTE in COMMERCIAL section]
MHL Article 9.60 (Kendra’s Law)
Emergency Medical Treatment
MHL Article 10 (Sex Offender Confinement-Initial)
Habeas Corpus
MHL Article 10 (Sex Offender Confinement-Review)
Local Court Appeal
MHL Article 81 (Guardianship)
Mechanic’s Lien
Other Mental Hygiene (specify):
Name Change
Other Special Proceeding (specify):
Pistol Permit Revocation Hearing
Sale or Finance of Religious/Not-for-Profit Property
OtherOF
STATUS ACTION OR PROCEEDING
(specify): 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: 06/3/2021
Has a summons and complaint or summons with notice been served? If yes, date served:
06/04/2021 and 06/07/2021
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: Return Date:
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: SCHENECTADY COUNTY CLERK 04/26/2022 12:11 PM INDEX NO. 2021-1129
NYSCEF DOC. NO. 8 RECEIVED NYSCEF: 04/26/2022
124217-01/MOS/
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 insurance
indicate if issue has
defendant, 3rd party plaintiff, etc.) been joined. carrier, if applicable.
Name: GEORGE SMITH FINKELSTEIN & PARTNERS, LLP
☐ 1279 Route 300, P.O. Box 1111, Newburgh, New York 12551
Tel. 845-562-0203 YES NO
Fax 845-562-3492
E-Mail: Efile@lawampm.com
Role(s): Plaintiff
Wilson, Elser, Moskowitz, Edelman, & Dicker, LLP
Name: NISKAYUNA OPERATING CO., LLC d/b/a
☐ PATHWAYS NURSING AND REHABILITATION1133 Westchester Avenue
White Plains, New York 10604 YES NO
CENTER and PATHWAYS NURSING AND
Tel. No. (914) 323-7000
REHABILITATION CENTER
E-Mail: lori.semlies@wilsonelser.com
Role(s): Defendants
Name: “JOHN and/or JANE DOE(S) and ABC
COMPANIES 1-10” whose names being
unknown and fictitious YES NO
Role(s): Defendants
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):
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.
4/26/2022
Dated:
Signature
2100402 LAWRENCE D. LISSAUER, ESQ.
Attorney Registration Number Print Name
2 of 2
Preview
FILED: SCHENECTADY COUNTY CLERK 04/26/2022 12:11 PM INDEX NO. 2021-1129 NYSCEF DOC. NO. 8 RECEIVED NYSCEF: 04/26/2022 UCS-840 REQUEST FOR JUDICIAL INTERVENTION (rev. 07/29/2019) SUPREME COURT, COUNTY OF SCHENECTADY 124217-01/MOS/ Index No: 2021-1129 Date Index Issued: 06/03/2021 For Court Use Only: 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 GEORGE SMITH, Judge Assigned Plaintiff(s)/Petitioner(s), -against- RJI Filed Date NISKAYUNA OPERATING CO., LLC d/b/a PATHWAYS NURSING AND REHABILITATION CENTER, PATHWAYS NURSING AND REHABILITATION CENTER, and “JOHN and/or JANE DOE(S) and ABC COMPANIES 1-10” whose names being unknown and fictitious, 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 Asbestos NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), Child Victims Act complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). Environmental (specify): REAL PROPERTY Specify how many properties the application includes: Medical, Dental or Podiatric Malpractice Condemnation Motor Vehicle Mortgage Foreclosure (specify): Residential Commercial Products Liability (specify): Property Address: Other Negligence (specify): PHL §2801-d claims and nursing home abuse, NOTE: For Mortgage Foreclosure actions involving a one to four-family, neglect, and mistreatment. 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 Tax Foreclosure SPECIAL PROCEEDINGS Other Real Property (specify): CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section] CPLR Article 78 (Body or Officer) Election Law OTHER MATTERS Extreme Risk Protection Order Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] MHL Article 9.60 (Kendra’s Law) Emergency Medical Treatment MHL Article 10 (Sex Offender Confinement-Initial) Habeas Corpus MHL Article 10 (Sex Offender Confinement-Review) Local Court Appeal MHL Article 81 (Guardianship) Mechanic’s Lien Other Mental Hygiene (specify): Name Change Other Special Proceeding (specify): Pistol Permit Revocation Hearing Sale or Finance of Religious/Not-for-Profit Property OtherOF STATUS ACTION OR PROCEEDING (specify): 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: 06/3/2021 Has a summons and complaint or summons with notice been served? If yes, date served: 06/04/2021 and 06/07/2021 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: Return Date: 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: SCHENECTADY COUNTY CLERK 04/26/2022 12:11 PM INDEX NO. 2021-1129 NYSCEF DOC. NO. 8 RECEIVED NYSCEF: 04/26/2022 124217-01/MOS/ 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 insurance indicate if issue has defendant, 3rd party plaintiff, etc.) been joined. carrier, if applicable. Name: GEORGE SMITH FINKELSTEIN & PARTNERS, LLP ☐ 1279 Route 300, P.O. Box 1111, Newburgh, New York 12551 Tel. 845-562-0203 YES NO Fax 845-562-3492 E-Mail: Efile@lawampm.com Role(s): Plaintiff Wilson, Elser, Moskowitz, Edelman, & Dicker, LLP Name: NISKAYUNA OPERATING CO., LLC d/b/a ☐ PATHWAYS NURSING AND REHABILITATION1133 Westchester Avenue White Plains, New York 10604 YES NO CENTER and PATHWAYS NURSING AND Tel. No. (914) 323-7000 REHABILITATION CENTER E-Mail: lori.semlies@wilsonelser.com Role(s): Defendants Name: “JOHN and/or JANE DOE(S) and ABC COMPANIES 1-10” whose names being unknown and fictitious YES NO Role(s): Defendants 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): 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. 4/26/2022 Dated: Signature 2100402 LAWRENCE D. LISSAUER, ESQ. Attorney Registration Number Print Name 2 of 2