Preview
FILED: ERIE COUNTY CLERK 03/16/2021 12:36 PM INDEX NO. 803362/2021
NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 03/16/2021
REQUEST FOR JUDICIAL INTERVENTION UCS-840
(rev. 07/29/2019)
Erie Supreme COURT, COUNTY OF Erie
Index No: 21022467 Date Index Issued: 02/11/2021 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
JOHN P. MEISENBURG, SHARON A. MEISENBURG
Judge Assigned
Plaintiff(s)/Petitioner(s)
-against-
THOMAS F. HUGHES III M.D., FARID BERENJI M.D., GENERAL PHYSICIAN, P.C.
RJI Filed Date
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING: Check only one box and specify where indicated.
COMMERCIAL MATRIMONIAL
☐ Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) ☐ Contested
NOTE: If there are children under the age of 18, complete and attach the
☐ Contract MATRIMONIAL RJI Addendum (UCS-840M).
☐ Insurance (where insurance company is a party, except arbitration)
For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
☐ UCC (includes sales and negotiable instruments)
☐ Other Commercial (specify):
TORTS
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). ☐ Asbestos
REAL PROPERTY: Specify how many properties the application includes:
☐ Child Victims Act
☐ Environmental (specify):
☐ Condemnation ☒ Medical, Dental, or Podiatric Malpractice
☐ Mortgage Foreclosure (specify): ☐ Residential ☐ Commercial ☐ Motor Vehicle
Property Address: ☐ Products Liability (specify):
NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner- ☐ Other Negligence (specify):
occupied residential property or owner-occupied condominium, complete and ☐ Other Professional Malpractice (specify):
attach the FORECLOSURE RJI ADDENDUM (UCS-840F).
☐ Other Tort (specify):
☐ Tax Certiorari - Section: Block: Lot:
SPECIAL PROCEEDINGS
☐ Tax Foreclosure
☐ Other Real Property (specify): ☐ CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section]
OTHER MATTERS
☐ CPLR Article 78 (Body or Officer)
☐ Election Law
☐ Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section]
☐ Extreme Risk Protection Order
☐ Emergency Medical Treatment
☐ MHL Article 9.60 (Kendra's Law)
☐ Habeas Corpus
☐ MHL Article 10 (Sex Offender Confinement-Initial)
☐ Local Court Appeal
☐ MHL Article 10 (Sex Offender Confinement-Review)
☐ Mechanic's Lien
☐ MHL Article 81 (Guardianship)
☐ Name Change
☐ Other Mental Hygiene (specify):
☐ Pistol Permit Revocation Hearing
☐ Other Special Proceeding (specify):
☐ Sale or Finance of Religious/Not-for-Profit Property
☐ Other (specify):
STATUS OF ACTION OR PROCEEDING: 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: 02/11/2021
Has a summons and complaint or summons with notice been served? ☒ ☐ If yes, date served: 02/17/2021
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: ERIE COUNTY CLERK 03/16/2021 12:36 PM INDEX NO. 803362/2021
NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 03/16/2021
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: MEISENBURG, JOHN P.
☐ DANIEL LARABY, Porter Nordby Howe LLP, 125 East
Jefferson Street 11th Floor, Syracuse, NY 13202, (315) ☐ YES ☒ NO
Role(s): Plaintiff/Petitioner 477-9900, dlaraby@pnhlawyers.com
Name: MEISENBURG, SHARON A.
☐ DANIEL LARABY, Porter Nordby Howe LLP, 125 East
Jefferson Street 11th Floor, Syracuse, NY 13202, (315) ☐ YES ☒ NO
Role(s): Plaintiff/Petitioner 477-9900, dlaraby@pnhlawyers.com
Name: HUGHES III, THOMAS F.
☐ MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING
, BUFFALO, NY 14202, mjr@connorsllp.com ☒ YES ☐ NO
Role(s): Defendant/Respondent
Name: BERENJI, FARID
☐ MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING
, BUFFALO, NY 14202, mjr@connorsllp.com ☒ YES ☐ NO
Role(s): Defendant/Respondent
Name: GENERAL PHYSICIAN, P.C.
☐ MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING
, BUFFALO, NY 14202, mjr@connorsllp.com ☒ YES ☐ NO
Role(s): Defendant/Respondent
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.
Dated: 03/16/2021 DANIEL PAUL LARABY
Signature
4920336 DANIEL PAUL LARABY
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 2
Preview
FILED: ERIE COUNTY CLERK 03/16/2021 12:36 PM INDEX NO. 803362/2021 NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 03/16/2021 REQUEST FOR JUDICIAL INTERVENTION UCS-840 (rev. 07/29/2019) Erie Supreme COURT, COUNTY OF Erie Index No: 21022467 Date Index Issued: 02/11/2021 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 JOHN P. MEISENBURG, SHARON A. MEISENBURG Judge Assigned Plaintiff(s)/Petitioner(s) -against- THOMAS F. HUGHES III M.D., FARID BERENJI M.D., GENERAL PHYSICIAN, P.C. RJI Filed Date Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING: Check only one box and specify where indicated. COMMERCIAL MATRIMONIAL ☐ Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) ☐ Contested NOTE: If there are children under the age of 18, complete and attach the ☐ Contract MATRIMONIAL RJI Addendum (UCS-840M). ☐ Insurance (where insurance company is a party, except arbitration) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13). ☐ UCC (includes sales and negotiable instruments) ☐ Other Commercial (specify): TORTS NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). ☐ Asbestos REAL PROPERTY: Specify how many properties the application includes: ☐ Child Victims Act ☐ Environmental (specify): ☐ Condemnation ☒ Medical, Dental, or Podiatric Malpractice ☐ Mortgage Foreclosure (specify): ☐ Residential ☐ Commercial ☐ Motor Vehicle Property Address: ☐ Products Liability (specify): NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner- ☐ Other Negligence (specify): occupied residential property or owner-occupied condominium, complete and ☐ Other Professional Malpractice (specify): attach the FORECLOSURE RJI ADDENDUM (UCS-840F). ☐ Other Tort (specify): ☐ Tax Certiorari - Section: Block: Lot: SPECIAL PROCEEDINGS ☐ Tax Foreclosure ☐ Other Real Property (specify): ☐ CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section] OTHER MATTERS ☐ CPLR Article 78 (Body or Officer) ☐ Election Law ☐ Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] ☐ Extreme Risk Protection Order ☐ Emergency Medical Treatment ☐ MHL Article 9.60 (Kendra's Law) ☐ Habeas Corpus ☐ MHL Article 10 (Sex Offender Confinement-Initial) ☐ Local Court Appeal ☐ MHL Article 10 (Sex Offender Confinement-Review) ☐ Mechanic's Lien ☐ MHL Article 81 (Guardianship) ☐ Name Change ☐ Other Mental Hygiene (specify): ☐ Pistol Permit Revocation Hearing ☐ Other Special Proceeding (specify): ☐ Sale or Finance of Religious/Not-for-Profit Property ☐ Other (specify): STATUS OF ACTION OR PROCEEDING: 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: 02/11/2021 Has a summons and complaint or summons with notice been served? ☒ ☐ If yes, date served: 02/17/2021 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: ERIE COUNTY CLERK 03/16/2021 12:36 PM INDEX NO. 803362/2021 NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 03/16/2021 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: MEISENBURG, JOHN P. ☐ DANIEL LARABY, Porter Nordby Howe LLP, 125 East Jefferson Street 11th Floor, Syracuse, NY 13202, (315) ☐ YES ☒ NO Role(s): Plaintiff/Petitioner 477-9900, dlaraby@pnhlawyers.com Name: MEISENBURG, SHARON A. ☐ DANIEL LARABY, Porter Nordby Howe LLP, 125 East Jefferson Street 11th Floor, Syracuse, NY 13202, (315) ☐ YES ☒ NO Role(s): Plaintiff/Petitioner 477-9900, dlaraby@pnhlawyers.com Name: HUGHES III, THOMAS F. ☐ MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO, NY 14202, mjr@connorsllp.com ☒ YES ☐ NO Role(s): Defendant/Respondent Name: BERENJI, FARID ☐ MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO, NY 14202, mjr@connorsllp.com ☒ YES ☐ NO Role(s): Defendant/Respondent Name: GENERAL PHYSICIAN, P.C. ☐ MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO, NY 14202, mjr@connorsllp.com ☒ YES ☐ NO Role(s): Defendant/Respondent 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. Dated: 03/16/2021 DANIEL PAUL LARABY Signature 4920336 DANIEL PAUL LARABY Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 2