Preview
FILED: CLINTON COUNTY CLERK 07/25/2023 10:17 AM INDEX NO. 2023-00023154
NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 07/25/2023
"CS"°
REQUEST FOR JUDICIAL INTERVENTION (rev.07/29/2019)
a
SUPREME
COURT, COUNTY OF CLINTON
... Index No: 2023-00023154 03/14/2023 For Court
Date Index issued: Use Only:
CAPTION Enter the complete case caption. Do not use et al or et ano. If rnore space is needed, attach a caption rider sheet. IAS Entry Date
AMERICAN EXPRESS NATIONAL BANK,
Plaintiff(s)/Petitioner(s) Judge Assigned
-against-
ADRIENNE DERUSHA
a/k/a ADRIENNE S. DERUSHA
RJiFiled Date
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING Check only one box and specify where indicated.
COMMERICIAL MATRIMONIAL
O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.) O Contested
O contract NOTE:it there are children under the age of 18, complete and attach the
O Insurance (where insurance company is a party, except arbitration) MATR\MONIAL Rit ADDENDUM (UCS-84DM).
O UCC(includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJi(UD-13).
O Other Commercial (specify): TORTS
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR202.70(d), Q Asbestos
complete and attach the COMMERCIALDIVfSIONRJIADDENDUM (UCS-840C). O Child Victims Act
REALPROPERTY Specify how many properties the application includes: O Environmental (specify):
O condemnation O Medical, Dental or Podiatric Malpractice
O Mortgage Foreclosure (specify): O Residential O commercial O Motor vehicle
Property Address: O Products Liability (specify):
NOTE:For Mortgage Foreclosure actions involving a one to four-family, O Other Negligence (specify):
owner-occupied residential property or owner-occupied condominium, O Other Professional Malpractice (specify):
complete and attach the FORECLOSURE
RJiADDENDUM (UCS-840F). O Other Tort (specify):
O Tax Certiorari SPECIALPROCEEDINGS
O Tax Foreclosure O CPLRArticle 75 (Arbitration) (see NOTE in COMMERCIALsection]
O Other Real Property (specify): O CPLRArticle 78 (Body or Officer)
OTHERMATTERS O Election Law
O certificate of Incorporation/Dissolution [see NOTEin COMMERCIALsection] O Extreme RiskProtection Order
O Emergency Medical Treatment O MHL Article 9.60 (Kendra's Law)
O HabeasCorpus O MHL Article 10 (SexOffender Confinement-Initial)
O LocalCourt Appeal O MHL Article 10 (SexOffender Confinement-Review)
O Mechanic's uen O MHL Article 81 (Guardianship)
O Name Change O Other Mental Hygiene (specify):
O Pistol Permit Revocation Hearing O Other Special Proceeding (specify):
O Saleor Finance of Religious/Not-for-Profit Property
Other (specify): CONSUMER CREDIT |CARD)TRANSACTIONORIGINAL
CREDITOR
PLAINTI
FF
STATUS OF ACTIONOR PROCEEDING Answer YESor NO for every questicn and enter additional information where indicated.
YES NO
Has a summons and complaint or summons with notice been filed? O If yes, date filed: 03/14/2023
Has a summons and complaint or summons with notice been served? If ves, date served: 04/11/2023
O
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,
O infanes compromise
O Extreme RiskProtection Order Application
O Note of Issue/Certificate of Readiness
O Notice of Medical, Dental or Podiatric Malpractice Date issue Joined:
Notice of Motion JUDGMENT-DEFAULT-JUDGMENT 08/07/2023
Relief Requested: Return Date:
O Notice of Petition Relief Requested: Return Date:
O Order to Show Cause Relief Requested: Return Date:
O Other ExParte Application Relief Requested:
O Poor Person Application
O Request for Preliminary Conference
O Residential Mortgage Foreclosure Settlement Conference
O Writ of HabeasCorpus
O Other (specify):
1 of 2
FILED: CLINTON COUNTY CLERK 07/25/2023 10:17 AM INDEX NO. 2023-00023154
NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 07/25/2023
REIATED 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 attachthe 1U1ADDENDUM (UCS-840A).
CaseTitle Index/Case Number Court judge (if assigned) Relationship to instant case
PAlfflES 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 WI ADDENDUM (UC5MB40A).
Un- Parties Attorneys and Unrupresented 1.itigants IssueJoined Insurance Carriers
Rap 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 deferidant,
caption and indicate roles (e.g., plaintiff, email, For unrepresented parties, provide party's address, phone and email. indicate if issue has indicate insurance
defendant, 3'd party plaintiff, etc.) been joined. carrier, if applicable.
Name: AMERICAN EXPRESSNATIONAL BANK
phae·1p7305-04H ru 1FN1]6·45$1 YES O NO
Role(s): Plaintiff
Name: mmoommaomenom ADRIENNEDARUSHAm/k/a ADRIENNES. DARUSHA
65 DUMONT ROAD O YES NO
Role(s): Defendant WESTCHAZY,NEW YORK12992
Name:
O YES NO
Role(s): Defendant
Name:
O YES NO
Role(s): Defendant
Name:
O YES O NO
Role(s):
Narne:
O YES O NO
Role(s):
Narne:
O YES O NO
Role(s):
Name:
O YES Q NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
I AFFIRM UNDER THE PENALTY OF PEUIIRY 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: n 2 .
nature
1090703 Anthony L Migliaccio, Jr., Esq.- 5taff Attorney for the Plaintiff
Attorney Registration Number Print Name
2 of 2
Preview
FILED: CLINTON COUNTY CLERK 07/25/2023 10:17 AM INDEX NO. 2023-00023154 NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 07/25/2023 "CS"° REQUEST FOR JUDICIAL INTERVENTION (rev.07/29/2019) a SUPREME COURT, COUNTY OF CLINTON ... Index No: 2023-00023154 03/14/2023 For Court Date Index issued: Use Only: CAPTION Enter the complete case caption. Do not use et al or et ano. If rnore space is needed, attach a caption rider sheet. IAS Entry Date AMERICAN EXPRESS NATIONAL BANK, Plaintiff(s)/Petitioner(s) Judge Assigned -against- ADRIENNE DERUSHA a/k/a ADRIENNE S. DERUSHA RJiFiled Date Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING Check only one box and specify where indicated. COMMERICIAL MATRIMONIAL O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.) O Contested O contract NOTE:it there are children under the age of 18, complete and attach the O Insurance (where insurance company is a party, except arbitration) MATR\MONIAL Rit ADDENDUM (UCS-84DM). O UCC(includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJi(UD-13). O Other Commercial (specify): TORTS NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR202.70(d), Q Asbestos complete and attach the COMMERCIALDIVfSIONRJIADDENDUM (UCS-840C). O Child Victims Act REALPROPERTY Specify how many properties the application includes: O Environmental (specify): O condemnation O Medical, Dental or Podiatric Malpractice O Mortgage Foreclosure (specify): O Residential O commercial O Motor vehicle Property Address: O Products Liability (specify): NOTE:For Mortgage Foreclosure actions involving a one to four-family, O Other Negligence (specify): owner-occupied residential property or owner-occupied condominium, O Other Professional Malpractice (specify): complete and attach the FORECLOSURE RJiADDENDUM (UCS-840F). O Other Tort (specify): O Tax Certiorari SPECIALPROCEEDINGS O Tax Foreclosure O CPLRArticle 75 (Arbitration) (see NOTE in COMMERCIALsection] O Other Real Property (specify): O CPLRArticle 78 (Body or Officer) OTHERMATTERS O Election Law O certificate of Incorporation/Dissolution [see NOTEin COMMERCIALsection] O Extreme RiskProtection Order O Emergency Medical Treatment O MHL Article 9.60 (Kendra's Law) O HabeasCorpus O MHL Article 10 (SexOffender Confinement-Initial) O LocalCourt Appeal O MHL Article 10 (SexOffender Confinement-Review) O Mechanic's uen O MHL Article 81 (Guardianship) O Name Change O Other Mental Hygiene (specify): O Pistol Permit Revocation Hearing O Other Special Proceeding (specify): O Saleor Finance of Religious/Not-for-Profit Property Other (specify): CONSUMER CREDIT |CARD)TRANSACTIONORIGINAL CREDITOR PLAINTI FF STATUS OF ACTIONOR PROCEEDING Answer YESor NO for every questicn and enter additional information where indicated. YES NO Has a summons and complaint or summons with notice been filed? O If yes, date filed: 03/14/2023 Has a summons and complaint or summons with notice been served? If ves, date served: 04/11/2023 O 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, O infanes compromise O Extreme RiskProtection Order Application O Note of Issue/Certificate of Readiness O Notice of Medical, Dental or Podiatric Malpractice Date issue Joined: Notice of Motion JUDGMENT-DEFAULT-JUDGMENT 08/07/2023 Relief Requested: Return Date: O Notice of Petition Relief Requested: Return Date: O Order to Show Cause Relief Requested: Return Date: O Other ExParte Application Relief Requested: O Poor Person Application O Request for Preliminary Conference O Residential Mortgage Foreclosure Settlement Conference O Writ of HabeasCorpus O Other (specify): 1 of 2 FILED: CLINTON COUNTY CLERK 07/25/2023 10:17 AM INDEX NO. 2023-00023154 NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 07/25/2023 REIATED 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 attachthe 1U1ADDENDUM (UCS-840A). CaseTitle Index/Case Number Court judge (if assigned) Relationship to instant case PAlfflES 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 WI ADDENDUM (UC5MB40A). Un- Parties Attorneys and Unrupresented 1.itigants IssueJoined Insurance Carriers Rap 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 deferidant, caption and indicate roles (e.g., plaintiff, email, For unrepresented parties, provide party's address, phone and email. indicate if issue has indicate insurance defendant, 3'd party plaintiff, etc.) been joined. carrier, if applicable. Name: AMERICAN EXPRESSNATIONAL BANK phae·1p7305-04H ru 1FN1]6·45$1 YES O NO Role(s): Plaintiff Name: mmoommaomenom ADRIENNEDARUSHAm/k/a ADRIENNES. DARUSHA 65 DUMONT ROAD O YES NO Role(s): Defendant WESTCHAZY,NEW YORK12992 Name: O YES NO Role(s): Defendant Name: O YES NO Role(s): Defendant Name: O YES O NO Role(s): Narne: O YES O NO Role(s): Narne: O YES O NO Role(s): Name: O YES Q NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): I AFFIRM UNDER THE PENALTY OF PEUIIRY 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: n 2 . nature 1090703 Anthony L Migliaccio, Jr., Esq.- 5taff Attorney for the Plaintiff Attorney Registration Number Print Name 2 of 2