On December 21, 2020 a
Party Statement
was filed
involving a dispute between
Community Memorial Hospital, Inc,
and
Jason Owen,
for Commercial - Contract
in the District Court of Madison County.
Preview
FILED: MADISON COUNTY CLERK 03/03/2021 11:53 AM INDEX NO. EF2020-1869
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 03/03/2021
SUPREME COURT COUNTY OF MADISON STATE OF NEW YORK
INDEX# 5 F 909o-176, 7
COMMUNITY MEMORIAL HOSPITAL, INC.
AFFIDAVIT OF FACTS
PLAINTIFF CONSTITUTING THE CLAIM
THE DEFAULT AND THE
-vs- AMOUNT DUE
JASON OWEN
DEFENDANT(S)
STATE OF NY]
COUNTY OF Madison] SS:
being duly sworn, dep0ses and says:
[PRINT N E]
That (s)he is the of Plaintiff Corporation
named in the above-entitled actics; that this Affidavit is made by depcnent because the Plaintiff is
a corporation; that Deponent's responsibilities, based on books and records maintained by the
Plaintiff, include overall supervision of Plaintiff's billing and callection for services rendered; this is
an action for the balance due for the agreed price and reasonable value of services furnished by
the Plaintiff to the Defendant at the specie! instance and request of the Defendant; that all fees
and charges billed to Defendant in this action are the usual and customary charges by Plaintiff for
the services charged; that this action was commenced by service of the Summons and
Complaint upon the Defendant.
WHEREFORE, Plaintiff demands Judgment against the Defendant in the sum of $1141.79 with
interest thereon from November 16, 2020, together with the costs and disbursements of this
action.
'
d
SWORN TO BEFORE ME THIS ROTHMAN EVANS, P.C.
Attorneys at Law
AY OF , 120 E. Washington Street
A O o 29 2o22.
NOTA PUBLIC MMI SION EXPIRES
Meghan Dougherty
Notary Public--State of New York
JFE:SLO
NO. 01DO6370099
19-15371-0
Qualified in Oneida Co n
My Commission Expires I R 2on
1 of 1
Document Filed Date
March 03, 2021
Case Filing Date
December 21, 2020
Category
Commercial - Contract
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FILED: MADISON COUNTY CLERK 03/03/2021 11:53 AM INDEX NO. EF2020-1869 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 03/03/2021 SUPREME COURT COUNTY OF MADISON STATE OF NEW YORK INDEX# 5 F 909o-176, 7 COMMUNITY MEMORIAL HOSPITAL, INC. AFFIDAVIT OF FACTS PLAINTIFF CONSTITUTING THE CLAIM THE DEFAULT AND THE -vs- AMOUNT DUE JASON OWEN DEFENDANT(S) STATE OF NY] COUNTY OF Madison] SS: being duly sworn, dep0ses and says: [PRINT N E] That (s)he is the of Plaintiff Corporation named in the above-entitled actics; that this Affidavit is made by depcnent because the Plaintiff is a corporation; that Deponent's responsibilities, based on books and records maintained by the Plaintiff, include overall supervision of Plaintiff's billing and callection for services rendered; this is an action for the balance due for the agreed price and reasonable value of services furnished by the Plaintiff to the Defendant at the specie! instance and request of the Defendant; that all fees and charges billed to Defendant in this action are the usual and customary charges by Plaintiff for the services charged; that this action was commenced by service of the Summons and Complaint upon the Defendant. WHEREFORE, Plaintiff demands Judgment against the Defendant in the sum of $1141.79 with interest thereon from November 16, 2020, together with the costs and disbursements of this action. ' d SWORN TO BEFORE ME THIS ROTHMAN EVANS, P.C. Attorneys at Law AY OF , 120 E. Washington Street A O o 29 2o22. NOTA PUBLIC MMI SION EXPIRES Meghan Dougherty Notary Public--State of New York JFE:SLO NO. 01DO6370099 19-15371-0 Qualified in Oneida Co n My Commission Expires I R 2on 1 of 1