On November 16, 2023 a
Exhibit,Appendix
was filed
involving a dispute between
Workers' Compensation Board Of The State Of New York,
and
J & J Bar-B-Que & Sausage Co Llc,
for Other Matters - Workers Comp App for Judgment
in the District Court of Steuben County.
Preview
FILED: STEUBEN COUNTY CLERK 11/16/2023 10:30 AM INDEX NO. E2023-1145CV
(48)16325282-1
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 11/16/2023
STATE OF NEW YORK
WORKERS'
NEw Workers, COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES
JUDGMENT UNIT PEOPLE WITH DISABILmES WITHOUT
Compensadon DISCRIMINATION.
Board 328 STATE STREET
SCHENECTADY, NY 12305-2318
866-298-7830
J & J BAR-B-QUE & SAUSAGE CO LLC WCB EMPLOYER #: 3010747
7 E MAIN ST UIER #: 53-42020
CANISTEO NY 14823-1126
FEIN/SS #: *****2540
It is hereby certified that this is a true
and correct copy of the original as filed
Workers'
with the Compensation Board
* ÖÖ"°
FINAL NOTICE
DATE: 10/10/2023
Non-Compliance
Item Description Dates Accident Date Balance Due
2022W0043284 Failure to Workers' Ins 08/22/2022-10/28/2022 $3,000..00
Carry Comp
Total Balance Due $3, 000. 00
*
If payment is not received immediately, judgment will be filed and the employer is subject to seizure
of assets, both business and personal, without further notice from the Board.
In order to insure prompt credit of your payment, complete the following with the
Date, Number and Amount of your check and return it, along with your payment to:
WORKERS'
COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET, SCHENECTADY, NY 12305-2318
Please detach and return bottom portion with your payment.
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
Employer J & J BAR-B-QUE & SAUSAGE CO LLC WCB Employer # 3010747
Customer ID #
Check
Check Date Check #
Amount
C-45.37 5/2004 Page 1 of 2
(48)18325282-1
Document Filed Date
November 16, 2023
Case Filing Date
November 16, 2023
Category
Other Matters - Workers Comp App for Judgment
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FILED: STEUBEN COUNTY CLERK 11/16/2023 10:30 AM INDEX NO. E2023-1145CV (48)16325282-1 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 11/16/2023 STATE OF NEW YORK WORKERS' NEw Workers, COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES JUDGMENT UNIT PEOPLE WITH DISABILmES WITHOUT Compensadon DISCRIMINATION. Board 328 STATE STREET SCHENECTADY, NY 12305-2318 866-298-7830 J & J BAR-B-QUE & SAUSAGE CO LLC WCB EMPLOYER #: 3010747 7 E MAIN ST UIER #: 53-42020 CANISTEO NY 14823-1126 FEIN/SS #: *****2540 It is hereby certified that this is a true and correct copy of the original as filed Workers' with the Compensation Board * ÖÖ"° FINAL NOTICE DATE: 10/10/2023 Non-Compliance Item Description Dates Accident Date Balance Due 2022W0043284 Failure to Workers' Ins 08/22/2022-10/28/2022 $3,000..00 Carry Comp Total Balance Due $3, 000. 00 * If payment is not received immediately, judgment will be filed and the employer is subject to seizure of assets, both business and personal, without further notice from the Board. In order to insure prompt credit of your payment, complete the following with the Date, Number and Amount of your check and return it, along with your payment to: WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET, SCHENECTADY, NY 12305-2318 Please detach and return bottom portion with your payment. MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. Employer J & J BAR-B-QUE & SAUSAGE CO LLC WCB Employer # 3010747 Customer ID # Check Check Date Check # Amount C-45.37 5/2004 Page 1 of 2 (48)18325282-1