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INDEX NO. EF2023-2999
NYSCEPDOE! NO. 2 RECEIVED NYSCEF 12/12/2023
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER
X
WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK,: JUDGMENT
Plaintiff,
-against- EMP# 23201923
JUD# : 2316481
ANSHSAHEJ Luc DBA MY MARKET
Defendant(s) INDEX # :
FILING DT: .
:
x
By order of the Chair of the Workers" Compensation Board of the State of New York, demand fer the
payment of the’sum of $500.00, representing Awards and Penalties having been made against the
above captioned Defendant(s), after due notice, ha ving defaulted in payment thereof, except the sum of
$0.00 leaving $500.00 due and payable.
NOW, upon the certified copies of notices attached hereto, and upon motion of the General Counsel of
the Workers' Compensation Board of the State of New York, attomey for Plaintiff, pursuant to Section ©
26 of the Workers' Compensation Law of the State of New York providing for entry of judgment by the
County Clerk in event of such default, it is ADJUDGED, that the Plaintiff, Workers' Compensation Board
of the State of New York, 328 State Street, Schenectady, NY 12305 does recover from the
above-captioned Defendant(s), whose last known address(es) are; 140.N CHESTNUT
ST, NEW PALTz,
NY 12561-1006, respectively; the sum of $500.00, and the Plaintiff have execution therefore.
Judgment signed tis: 12th day of December 2023
Clerk :
Scott T. Harms, Esq.
Attorney for Plaintiff
Workers’ Compensation Board
328 State St.
Schenectady, NY 12305
C-45 6/2007
notesrients
lof 5
= INDEX NO. EF2023-2999
NYSCBRs0e NO. 2 RECEIVED NYSCEF: 12/12/2023
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER
X
WORKERS’ COMPENSATION BOARD OF THE STATE OF NEW YORK,:
Plaintiff,
-against-
ANSHSAHEJ LLC DBA MY MARKET
Defendant(s)
AFFIRMATION
OF
REGULARITY
x
The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New
York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon
Information and belief:
This affirmation is based upon
u a review of the file which is maintained by the Workers' Compensation
Board in its regular course of business.
The Workers! Compensation Board of the State of New York, in accordance with the provisions of the
Workers’ Compensation Law, has made an assessment/award in the sum of $500.00, against the
defendant(s). Attached’ hereto and made a part hereof are certified copies of the Notice of Decision and
Award, and/or a.certified copy of the demand for deposit of security, and/or a certified copy of the chairs
order imposing, and the demand for payment of, assessments imposed by the chair pursuant to
subdivision five of section fifty-two and/or one hundred thirty one of the Workers’ Compensation Law, as
required for filing of judgment per Workers’ Compensation Law, Section 26 and/or 219. Appeals before
the Board have been exhausted.
No payment of award has been made except $0.00, leaving $500.00 due and payable.
WHEREFORE, itiis respectfully requested that judgment be entered against the Defendant(s) herein in
the sum stated as remaining due and payable.
Dated day of Seeunber D023
A Michalen A Lesley,
MicheleA. Mealy, Esq.
C-45.1 4/2007
cigiesmesd
2 0f 5
= INDEX NO. ,EF2023-2999
NYSGR
Fes OE. NO. 2 RECEIVED NYSCEF: 12/12/2023
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER
X
WORKERS’ COMPENSATION BOARD OF THE STATE OF NEW YORK,:
Plaintiff,
against
ANSHSAHEJ LLC DBA MY MARKET
AFFIRMATION
Defendant(s)
OF
NON-PAYMENT
x
The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New
York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon
information and belief:
This affirmationiis based upon a review of the file which is maintained by the Workers’ Compensation
Board in its regular course of business.
1am familiar with the's status of payment in this matter. The award/penalty/assessment/demand for
deposit of security made against the defendant(s) in the amount of $500.00 is in default, as more than
thirty days have elapsed since the demand upon the defendant(s) herein for payment. No payment has
been received nor has the aforesaid security been deposited in compliance with said demand to date,
except the sum of $0.00, leaving due and payble the sum of $500.00.
Dated yy 4 day of _€ernbes 2
Mahle ALliaty
Michele A. Mealy, Esq
C-45.45 1/2009
dueqnearioset
3 0f 5
=: INDEX NO. EF2023-2999
NYS@&7DOG. NO. 2 RECEIVED NYSCEF: 12/12/2023
: STATE OF NEW YORK
He
NEW Workers’ WORKERS’ COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES.
YORK JUDGMENT UNIT
‘STATE Compensation PEOPLE WITH DISABILITIES MITHOUT
Boar 328 STATE STREET DISCRIMINATION.
SCHENECTADY, NY 12305-2318
866-298-7830
ANSHSAHEJ LLC WCB EMPLOYER #: 3201923
DBA MY MARKET UIER #: 55-30615
140 N CHESTNUT ST
NEW PALTZ NY 12561-1006 FEIN/SS #: *we9592
Itis hereby certified that this is a true
and correct copy of the original as filed
with the Workers’ Compensation Beard
Merrne
Judgm ft Unit
DATE: 10/31/2023 FINAL ICE * Hl.
Certified on oresnede eel
Non-Compliance
item Description Dates Accident Date| Balance Due
J2022W0045725 Failure to Carry Workers' Comp Ins 09/14/2022-09/29/2022 $500.00
ffotal Balance Due $500.00
* 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.
PAYMENT INSTRUCTIONS
To make online payments e-mail OR
In order to insure prompt credit of your payment, complete the following with the
Date, Number and Amount of your check and retum it, along with your payment to:
NYS WORKERS' COMPENSATION BOARD
PO BOX 5530
BINGHAMTON, NY 13902-5530
mete nae Please COTA ach
SS de! and return
CH ang return botto
Dotto n_portion with your payment. pees nee ne —
MAKE CHECKS PAYABLE TO "COMMISSIONER OF TAXATION AND FINANCE”.
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
Employer | ANSHSAHEJ LLC DBA MY MARKET WCB Employer# | 3201923
Customer ID #
Check Date Check # Check
Amount
C-45.37 10/2023 Page 1 of 2
(resin 4 of 5
INDEX NO. EF2023-2999
NYSCEF D fant! 2 Non-Compliance RECEIVED) NYSCEF: 12; 12/2023
Description Dates Accident Date ] Balance Due
MAKE CHECKS PAYABLE TO "COMMISSIONER OF TAKATION AND FINANCE"
a
Mail payment along with this form to:
NYS.WORKERS' COMPENSATION BOAR
ve
PO BOX 5530
BINGHAMTON, NY 13902-5530
C-45.37 10/2023 Page 2 of 2
5 of 5
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INDEX NO. EF2023-2999 NYSCEPDOE! NO. 2 RECEIVED NYSCEF 12/12/2023 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER X WORKERS' COMPENSATION BOARD OF THE STATE OF NEW YORK,: JUDGMENT Plaintiff, -against- EMP# 23201923 JUD# : 2316481 ANSHSAHEJ Luc DBA MY MARKET Defendant(s) INDEX # : FILING DT: . : x By order of the Chair of the Workers" Compensation Board of the State of New York, demand fer the payment of the’sum of $500.00, representing Awards and Penalties having been made against the above captioned Defendant(s), after due notice, ha ving defaulted in payment thereof, except the sum of $0.00 leaving $500.00 due and payable. NOW, upon the certified copies of notices attached hereto, and upon motion of the General Counsel of the Workers' Compensation Board of the State of New York, attomey for Plaintiff, pursuant to Section © 26 of the Workers' Compensation Law of the State of New York providing for entry of judgment by the County Clerk in event of such default, it is ADJUDGED, that the Plaintiff, Workers' Compensation Board of the State of New York, 328 State Street, Schenectady, NY 12305 does recover from the above-captioned Defendant(s), whose last known address(es) are; 140.N CHESTNUT ST, NEW PALTz, NY 12561-1006, respectively; the sum of $500.00, and the Plaintiff have execution therefore. Judgment signed tis: 12th day of December 2023 Clerk : Scott T. Harms, Esq. Attorney for Plaintiff Workers’ Compensation Board 328 State St. Schenectady, NY 12305 C-45 6/2007 notesrients lof 5 = INDEX NO. EF2023-2999 NYSCBRs0e NO. 2 RECEIVED NYSCEF: 12/12/2023 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER X WORKERS’ COMPENSATION BOARD OF THE STATE OF NEW YORK,: Plaintiff, -against- ANSHSAHEJ LLC DBA MY MARKET Defendant(s) AFFIRMATION OF REGULARITY x The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon Information and belief: This affirmation is based upon u a review of the file which is maintained by the Workers' Compensation Board in its regular course of business. The Workers! Compensation Board of the State of New York, in accordance with the provisions of the Workers’ Compensation Law, has made an assessment/award in the sum of $500.00, against the defendant(s). Attached’ hereto and made a part hereof are certified copies of the Notice of Decision and Award, and/or a.certified copy of the demand for deposit of security, and/or a certified copy of the chairs order imposing, and the demand for payment of, assessments imposed by the chair pursuant to subdivision five of section fifty-two and/or one hundred thirty one of the Workers’ Compensation Law, as required for filing of judgment per Workers’ Compensation Law, Section 26 and/or 219. Appeals before the Board have been exhausted. No payment of award has been made except $0.00, leaving $500.00 due and payable. WHEREFORE, itiis respectfully requested that judgment be entered against the Defendant(s) herein in the sum stated as remaining due and payable. Dated day of Seeunber D023 A Michalen A Lesley, MicheleA. Mealy, Esq. C-45.1 4/2007 cigiesmesd 2 0f 5 = INDEX NO. ,EF2023-2999 NYSGR Fes OE. NO. 2 RECEIVED NYSCEF: 12/12/2023 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER X WORKERS’ COMPENSATION BOARD OF THE STATE OF NEW YORK,: Plaintiff, against ANSHSAHEJ LLC DBA MY MARKET AFFIRMATION Defendant(s) OF NON-PAYMENT x The undersigned, an attorney in the office of the Workers' Compensation Board of the State of New York, Plaintiff herein, hereby affirms that the following is true under the penalty of perjury, upon information and belief: This affirmationiis based upon a review of the file which is maintained by the Workers’ Compensation Board in its regular course of business. 1am familiar with the's status of payment in this matter. The award/penalty/assessment/demand for deposit of security made against the defendant(s) in the amount of $500.00 is in default, as more than thirty days have elapsed since the demand upon the defendant(s) herein for payment. No payment has been received nor has the aforesaid security been deposited in compliance with said demand to date, except the sum of $0.00, leaving due and payble the sum of $500.00. Dated yy 4 day of _€ernbes 2 Mahle ALliaty Michele A. Mealy, Esq C-45.45 1/2009 dueqnearioset 3 0f 5 =: INDEX NO. EF2023-2999 NYS@&7DOG. NO. 2 RECEIVED NYSCEF: 12/12/2023 : STATE OF NEW YORK He NEW Workers’ WORKERS’ COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES. YORK JUDGMENT UNIT ‘STATE Compensation PEOPLE WITH DISABILITIES MITHOUT Boar 328 STATE STREET DISCRIMINATION. SCHENECTADY, NY 12305-2318 866-298-7830 ANSHSAHEJ LLC WCB EMPLOYER #: 3201923 DBA MY MARKET UIER #: 55-30615 140 N CHESTNUT ST NEW PALTZ NY 12561-1006 FEIN/SS #: *we9592 Itis hereby certified that this is a true and correct copy of the original as filed with the Workers’ Compensation Beard Merrne Judgm ft Unit DATE: 10/31/2023 FINAL ICE * Hl. Certified on oresnede eel Non-Compliance item Description Dates Accident Date| Balance Due J2022W0045725 Failure to Carry Workers' Comp Ins 09/14/2022-09/29/2022 $500.00 ffotal Balance Due $500.00 * 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. PAYMENT INSTRUCTIONS To make online payments e-mail OR In order to insure prompt credit of your payment, complete the following with the Date, Number and Amount of your check and retum it, along with your payment to: NYS WORKERS' COMPENSATION BOARD PO BOX 5530 BINGHAMTON, NY 13902-5530 mete nae Please COTA ach SS de! and return CH ang return botto Dotto n_portion with your payment. pees nee ne — MAKE CHECKS PAYABLE TO "COMMISSIONER OF TAXATION AND FINANCE”. PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. Employer | ANSHSAHEJ LLC DBA MY MARKET WCB Employer# | 3201923 Customer ID # Check Date Check # Check Amount C-45.37 10/2023 Page 1 of 2 (resin 4 of 5 INDEX NO. EF2023-2999 NYSCEF D fant! 2 Non-Compliance RECEIVED) NYSCEF: 12; 12/2023 Description Dates Accident Date ] Balance Due MAKE CHECKS PAYABLE TO "COMMISSIONER OF TAKATION AND FINANCE" a Mail payment along with this form to: NYS.WORKERS' COMPENSATION BOAR ve PO BOX 5530 BINGHAMTON, NY 13902-5530 C-45.37 10/2023 Page 2 of 2 5 of 5