Preview
INDEX NO. 150318/2017
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 05/17/2017
REQUEST FOR JUDICIAL INTERVENTION For Court Clerk Use Only:
Ucs-840 (7/2012) TAS Entry Date
Supreme COURT, COUNTY OF New York oi
Wdge Assigned
Index No: 150318/17E Date Index Issued: 1/10/17
Enter the complete case caption. Do not use et al or et ano. If more space is required, RIT Date
CAPTION: attach a caption rider sheet.
CALVIN ELLISON,
Plaintiff(s)/Petitioner(s)
“against
LTB MECHANICAL CORP. and MICHAEL BUTLER,
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING: Check ONE box only and specify where indicated.
MATRIMONIAL. COMMERCIAL
O contested © Business Entity (including corporations, partnerships, LLCs, etc.)
NOTE: For all Matrimonial actions where the parties have children under O contract
the age of 18, complete and attach the MATRIMONIAL RJI Addendum. O Insurance (where insurer is a party, except arbitration)
For Uncontested Matrimonial actions, use RJI form UD-13. OUCC (including sales, negotiable instruments)
TORTS O other Commercial:
O Asbestos (speciy)
O Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR §
© Environmental: 202.70(d)], complete and attach the COMMERCIAL DIV Rul Addendum.
(specify) REAL PROPERTY: How many properties does the application include?
O Medical, Dental, or Podiatric Malpractice Condemnation
© Motor Vehicle O Mortgage Foreclosure (speciy): Oresidential O commercial
O Products Liability: Property Address:
(specify) ‘Street Address City State 2p
O other Negligence: NOTE: For Mortgage Foreclosure actions involving a one- to four-family,
(specity) owner-occupied, residential property, or an owner-occupied
O other Professional Malpractice: condominium, complete and attach the FORECLOSURE RJI Addendum.
(specify) O Tax Certiorari - Section Block: Lot:
O other Tort: O Tax Foreclosure
(specify) O other Real Property:
OTHER MATTERS (specity)
‘© Certificate of Incorporation/Dissolution [see NOTE under Commercial] SPECIAL PROCEEDINGS
O Emergency Medical Treatment OCPLR Article 75 (Arbitration) [see NOTE under Commercial]
Ondabeas Corpus OCcPLR Article 78 (Body or Officer)
O Local Court Appeal O lection Law
O Mechanic's Lien OMIL Article 9.60 (Kendra's Law)
Ovame Change OMIHL Article 10 (Sex Offender Confinement-Initial)
O Pistol Permit Revocation Hearing OMHL Article 10 (Sex Offender Confinement-Review)
OSale or Finance of Religious/Not-for-Profit Property OMIHL Article 81 (Guardianship)
O Other: © other Mental Hygiene:
(specify) (specify)
O other Special Proceeding:
(specify)
STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated.
Has a summons and complaint or summons winotice been filed?
Lyes [NO J Iyes, date filed: 1/10/17
© oO
Has a summons and complaint or summons winotice been served? © 0 If yes, date served:
Is this action/proceeding being filed post-judgment? oo Ifyes, judgment dat
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INDEX NO. 150318/2017
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 05/17/2017
NATURE OF JUDICIAL INTERVENTION: Check ONE box only AND enter additional information where indicated.
Infant's Compromise
O Note of issue and/or Certificate of Readiness
O Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined:
© Notice of Motion Relief Sought: Discovery E21 Return Date: 6/12/17
O Notice of Petition Relief Sought: Return Date:
O order to Show Cause Relief Sought Return Date:
O other Ex Parte Application Relief Sought:
© Poor Person Application
O Request for Preliminary Conference
O Residential Mortgage Foreclosure Settlement Conference
O writ of Habeas Corpus
O Other (specify):
List any related actions. For Matrimonial actions, include any related criminal and/or Family Court cases.
RELATED CASES: If additional space is required, complete and attach the RJl Addendum. If none, leave blank.
Case Title Index/Case No. Court Judge (if assigned) Relationship to Instant Case
For parties without an attorney, check "Un-Rep” box AND enter party address, phone number and e-mail address in space provided,
PARTIES: If additional space is required, complete and attach the RJI Addendum.
Parties: Attorneys and/or Unrepresented Litigants: issue
Un- List parties in caption order and Provide attorney name, firm name, business address, phone number and e-mail Joined
Insurance
Carrier(s):
Rep |indicate party role(s) (e.g. defendant; address of all attorneys that have appeared in the case. For unrepresented (YIN):
3rd-party plaintiff) litigants, provide address, phone number and e-mail address.
Ellison
Last Name Last Name First Namo
yes
Calvin James Newman, P.C.
First Name Firm Name
O Primary Role: 12815 Waterbury Avenue Bronx New York] 10461
Plaintiff
Secondary Role (if any):
a Street Address city State Zip
(no
17188233122
Phone Fax e-mail
LTB Mechanical Corp. State Farm Mutual
Last Name Last Name First Name Automobile
yes
Kelly. Rode & Kelly, LLP Insurance Company
First Namo Firm Name
Primary Role: 330 Old Country Road, Suite 305 Mineola New York] 11501
Defendant
‘Secondary Role (if any):
& Street Address city State Zip
Ino
5167390400 5167390434 infoekrklawcom
Phone Fax e-mail
Butler State Farm Mutual
Last Name Last Name First Name
yes Automobile
Michael kelly, Rode & Kelly, LLP Insurance Company
First Name Firm Name
Primary Role: 1330 Old Country Road, Suite 305 Mineola Now York] 11501
Defendant
Secondary Role (if any}
& Street Address. city State Zip
Ono
15167390400 5167390434 info@krklaw,com
Phono Fax e-mail
Last Name Last Name First Name
(ves
First Name Firm Name
O Primary Role:
Street Address City State Zip (Ono
‘Secondary Role (if any):
Phone Fax e-mail
| AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE
BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION PREVIOUSLY BEEN FILED IN
THIS ACTION OR PROCEEDING.
Dated: May 15, 2017
2860922
Ginn ae SIGN,
Loris Zeppieri
ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME
2 of 2
Preview
INDEX NO. 150318/2017 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 05/17/2017 REQUEST FOR JUDICIAL INTERVENTION For Court Clerk Use Only: Ucs-840 (7/2012) TAS Entry Date Supreme COURT, COUNTY OF New York oi Wdge Assigned Index No: 150318/17E Date Index Issued: 1/10/17 Enter the complete case caption. Do not use et al or et ano. If more space is required, RIT Date CAPTION: attach a caption rider sheet. CALVIN ELLISON, Plaintiff(s)/Petitioner(s) “against LTB MECHANICAL CORP. and MICHAEL BUTLER, Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING: Check ONE box only and specify where indicated. MATRIMONIAL. COMMERCIAL O contested © Business Entity (including corporations, partnerships, LLCs, etc.) NOTE: For all Matrimonial actions where the parties have children under O contract the age of 18, complete and attach the MATRIMONIAL RJI Addendum. O Insurance (where insurer is a party, except arbitration) For Uncontested Matrimonial actions, use RJI form UD-13. OUCC (including sales, negotiable instruments) TORTS O other Commercial: O Asbestos (speciy) O Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR § © Environmental: 202.70(d)], complete and attach the COMMERCIAL DIV Rul Addendum. (specify) REAL PROPERTY: How many properties does the application include? O Medical, Dental, or Podiatric Malpractice Condemnation © Motor Vehicle O Mortgage Foreclosure (speciy): Oresidential O commercial O Products Liability: Property Address: (specify) ‘Street Address City State 2p O other Negligence: NOTE: For Mortgage Foreclosure actions involving a one- to four-family, (specity) owner-occupied, residential property, or an owner-occupied O other Professional Malpractice: condominium, complete and attach the FORECLOSURE RJI Addendum. (specify) O Tax Certiorari - Section Block: Lot: O other Tort: O Tax Foreclosure (specify) O other Real Property: OTHER MATTERS (specity) ‘© Certificate of Incorporation/Dissolution [see NOTE under Commercial] SPECIAL PROCEEDINGS O Emergency Medical Treatment OCPLR Article 75 (Arbitration) [see NOTE under Commercial] Ondabeas Corpus OCcPLR Article 78 (Body or Officer) O Local Court Appeal O lection Law O Mechanic's Lien OMIL Article 9.60 (Kendra's Law) Ovame Change OMIHL Article 10 (Sex Offender Confinement-Initial) O Pistol Permit Revocation Hearing OMHL Article 10 (Sex Offender Confinement-Review) OSale or Finance of Religious/Not-for-Profit Property OMIHL Article 81 (Guardianship) O Other: © other Mental Hygiene: (specify) (specify) O other Special Proceeding: (specify) STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated. Has a summons and complaint or summons winotice been filed? Lyes [NO J Iyes, date filed: 1/10/17 © oO Has a summons and complaint or summons winotice been served? © 0 If yes, date served: Is this action/proceeding being filed post-judgment? oo Ifyes, judgment dat 1 of 2 INDEX NO. 150318/2017 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 05/17/2017 NATURE OF JUDICIAL INTERVENTION: Check ONE box only AND enter additional information where indicated. Infant's Compromise O Note of issue and/or Certificate of Readiness O Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined: © Notice of Motion Relief Sought: Discovery E21 Return Date: 6/12/17 O Notice of Petition Relief Sought: Return Date: O order to Show Cause Relief Sought Return Date: O other Ex Parte Application Relief Sought: © Poor Person Application O Request for Preliminary Conference O Residential Mortgage Foreclosure Settlement Conference O writ of Habeas Corpus O Other (specify): List any related actions. For Matrimonial actions, include any related criminal and/or Family Court cases. RELATED CASES: If additional space is required, complete and attach the RJl Addendum. If none, leave blank. Case Title Index/Case No. Court Judge (if assigned) Relationship to Instant Case For parties without an attorney, check "Un-Rep” box AND enter party address, phone number and e-mail address in space provided, PARTIES: If additional space is required, complete and attach the RJI Addendum. Parties: Attorneys and/or Unrepresented Litigants: issue Un- List parties in caption order and Provide attorney name, firm name, business address, phone number and e-mail Joined Insurance Carrier(s): Rep |indicate party role(s) (e.g. defendant; address of all attorneys that have appeared in the case. For unrepresented (YIN): 3rd-party plaintiff) litigants, provide address, phone number and e-mail address. Ellison Last Name Last Name First Namo yes Calvin James Newman, P.C. First Name Firm Name O Primary Role: 12815 Waterbury Avenue Bronx New York] 10461 Plaintiff Secondary Role (if any): a Street Address city State Zip (no 17188233122 Phone Fax e-mail LTB Mechanical Corp. State Farm Mutual Last Name Last Name First Name Automobile yes Kelly. Rode & Kelly, LLP Insurance Company First Namo Firm Name Primary Role: 330 Old Country Road, Suite 305 Mineola New York] 11501 Defendant ‘Secondary Role (if any): & Street Address city State Zip Ino 5167390400 5167390434 infoekrklawcom Phone Fax e-mail Butler State Farm Mutual Last Name Last Name First Name yes Automobile Michael kelly, Rode & Kelly, LLP Insurance Company First Name Firm Name Primary Role: 1330 Old Country Road, Suite 305 Mineola Now York] 11501 Defendant Secondary Role (if any} & Street Address. city State Zip Ono 15167390400 5167390434 info@krklaw,com Phono Fax e-mail Last Name Last Name First Name (ves First Name Firm Name O Primary Role: Street Address City State Zip (Ono ‘Secondary Role (if any): Phone Fax e-mail | AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION PREVIOUSLY BEEN FILED IN THIS ACTION OR PROCEEDING. Dated: May 15, 2017 2860922 Ginn ae SIGN, Loris Zeppieri ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME 2 of 2