On May 12, 2023 a
EXHIBIT(S) - C (Motion #001) - CERTIFIED POLICE REPORT
was filed
involving a dispute between
Robin Ellis,
and
Michael E. Oswald,
The Village Of Rockville Centre,
for Torts - Motor Vehicle
in the District Court of Nassau County.
Preview
INDEX NO. 607676/2023
NYSCEF DOC. NO. 29 RECEIVED NYSCEF: 12/28/2023
Exhibit C
iA AU OUN WV INDEX NO. 607676/20:
10
NY¥SEER 1.AGE Tek 7 2reee New York State ‘of Motor Vehicles RECEIVED NYSCEF: 12/28/2923
POLICE ACCIDENT REPORT
MY-104A (6/04) 18
GKRCI5FD98KQ
oO a rs 7 DMV COPY
(Accident Day
of Week Miltary Time No. of No. injured’ No. Killed]
poe ‘atScone[] | Lett Scene] Police Photos 20
‘Month/Day, ee -
29 2022 FRIDAY 15:25 1 0 [Accident Reconstructed C1 O | Gives Ono
VEHICLE 1 VEHICLE 2 OBSICYCUST [J] PEDESTRIAN [J OTHER PEDESTRIAN
VEHICLE1-
License ID Number _ 472976078
OfLic, | VEHICLE 2 - Driver
IDNumber 467102777 Pay a
i eran iene, OSWALD, MICHAEL EDWARD DriverName - exactly
pepihtad
on tesnee ELLIS, ROBIN D
[Address (Inciuxta Number & Siroa!) "ABE NO. | Address (include Number & Streat) ‘Apt. No.
1966 JACKSON AVE 316 BALDWIN RD FL 1
‘or Town
EAFORD NY 117830000 ‘STEAD 115500000
Unlicensed No.of ‘Sex Unlicensed No.of
Occupants Property:
3 1839 o Damaged
C1) 17 1975 M Oeneetts Damaged
Name-exactly
as printed on registration ‘Name-exactly
as printed on registration 23
[tee]2” [ie
|Datoof
ROCKVILLE, CENTRE V Morin | ay ] Yeo | eltis, shernice
[Ackiress (Incluxa Numbor & Siroat) [Apt No. | Haz. Released | Address (include Number & Streat) [Apt No. [Haz
4 | Po BOX 950 316 BALDWIN RD FL 1 Mat.
ma
i
1
ROCKVILLE CENTRE HEMPSTEAD NY 115500000
Plata Number [State
of Reg.| Vehicle
Year & Make [state
of Reg. |Vehicie
Year & Make (Vehice Type ins. Code
AY8768 NY 2016 cuey [BUS SS9T NJ 2013 BMW SUBN 733
ff
1 Number(s) ee é SSF EX
Violation
Bection(s) ps.
25
‘Check
if Involved vehici "| Check ifinvotved it describes
the accident, or draw your own
more than 96 Inches wide; \\ Sioa
inge napc N er. the vehicles.
1 more than 34 feet
1 operated with an overweight
permit;
‘Ernore naira tet ae 24s 5G Pawo Right Tum [Head On
1 operated with an over permit. \hail oper Ove permit ><
VEHICLE 1 DAMAGE CODES: 4 ace
a
uh ‘Sideswipe
Box 1 - Point
of Impact Box 1 Point of impact Nie (opposite direction)
1
4 Se
ines: [ACCIDENT DIAG!
Enter up to three
more
3
mow i
a ace 4% a7
[Vehicle
By
Nee tS
To Petters ae
is (0 accident
| diagram
V4
VEHICLE DAMAGE CODING: 5 f |
4-13. SEE DIAGRAM ON RIGHT. as (i
44, UNDERCARRIAGE 417. DEMOLISHED. —" she
15. TRAILER 18. NO DAMAGE
16. OVERTURNED 19. OTHI Of iépairs to any aca be yan $1000.
7 DiUsieiown/Unabie to Determine es__CONo
Reference Marker | Coordinates (available) _ Were Accidr aS bh
Latitude/Northing: Ociy G Vilage O Town of ROCKVILLE CENTER, VILLAGE OF
Road on which accident ocourred CEDAR AVE
(Route Number or Street Namo)
at 1) intersecting
street_ HEMPSTEAD AVE
(Route Number
or Street Name)
or2) Oe OW of
‘uliopost, Nearest intersecting Route Number or Steot Name)
Accident Description/Officer’s Notes
Operator of MV 1 states he was turning right from northbound Hempstead Ave onto eastbound Cedar Ave.
Operator of MY1 states that due to the large size of his vehicle, he had to make a wide turn,
causingthe front end of his vehicle to enter the oncoming lane, where he collided with MV2. ant
Operator of MV2 states he was driving westbound on Cedar Ave and slowing down while approaching the
8 2 410 44 12 413 44 45 16 47_ BY TO 18 Date of Only.
ajOl 1 4 1 162 M = OSWALD, MICHAEL EDWARD
Bj02 1 4 1 46 iM. 12 6 4468 2911 ELLIS, ROBIN D
cf0l 6 4 1 [92 iF iS HODGINS, MARIA J
pj 01 4 4 1 81 F E YOUNG, BEATRICE K
E
F
|Officer’s Rank
land Signature. pro Ger Pom Badge/ID No. NCIG No. |Preci
Troop/Zone | Sector
‘Station/Beat/ Reviewing
Officer
[Date/Time Reviewed
lin Full M BONCORE 464 02909
| LRC CLARK,D (04/29/2022 17:36
This is to certify that this document is a true and complete copy of a record on lade SF reedln*
OS
filein the New York State Department of Motor Vehicles, Albany, New York. COMMISSIONER OF MOTOR VEHICLES
a =: INDEX NO. 607676/2023
NSE Qo. 27 — Now York State Department of Motor Vehicles RECEIVED NYSCEF: 12/28/ g 3
POLICE ACCIDENT REPORT
MV-104A (6/04)
GKRCISFD98KQ Om 1) tit ee A DMV COPY
7
Accident Date. Day
of Waek Miltary Time No. Injured
. Nehies No. Killed] ‘ot
soneinvestigatedat Soane [] | “8! Soene | Police Photos
re Tee
04 29 “9022 FRIDAY 15:25 2 1 Accident Reconstructed CI o Elves ONo
VEHICLE 1 OD VEHICLE 2 OUBICYCUST [J PEDESTRIAN [1] OTHER PEDESTRIAN
VEHICLE 1- Driver [Stale
of Lic. [| VEHICLE 2 - Driver [State
of Lic.
License IO Number Ucense 1D Number aT
Driver Name -exactly Driver Name - exactly
as printed on license as printed on ficense
[Address (Inciuxto Number & Strout) Api. NO. | Address (include Numbor & Siroaty “Apt. No.
Gily
oF Town Zip Code (City
or Town Zip Code
Uniicensed No.of Unlicensed
: penn | Oa | vow] ‘Occupants Fey, af | ==] Occupants
— PEL
Boras
Name-exactly
as printed on registration Name-exactly
as printed on registration
Day Year
[Ackiross (Incluxia Numbor & Siro!) ‘Apt No. | Haz. Released || Address (includa Numbar
& Streat) JApt. No. [Haz.
Mat.
o
City
oF Town ‘State Zip Code. ‘Cy
ok Town State
Zip Code. a
\)
Plate Number State
of Reg. | Vehicle
Year & Make Vehicle Type [State of Reg. |Vehicie Year
& Make Vehicle Type ins. Code
mus eo
{E
BD
TicketiArrast
Number(s) @ nat
Violation
Bection(s) ji.
ip Salat |
‘Cheok if involved vehicle Is: [72 ‘Winvolved sai {that it describes the accident, or draw your own
Cl more than 96 Inches wide; re er.the vehicles.
D1 more than 34 feet long; ‘i
\ ‘Angie [Right Tum [Head On
Cl operated with an overweightpermi
1 operated with an overdimension permit. \ er ><
VEHICLE 1 DAMAGE CODES
a
sity ‘Sideswipe
Box 1 - Point of Impact Box 1)"
a
intof pact
a
Tete iretlon) MhAM (opposite direction)
it
“7
Box 2 - Most Damage Box 2 Damege.—
Enter
up to three
more Damage.
3
‘ ps
i
i ae
[Vehicle By ; oF
[Towed ey #4 Bt
To a oie
pt diagram
VEHICLE DAMAGE CODING: Wy I ley
t iq
413. SEE DIAGRAM ON RIGHT.
44. UNDERCARRIAGE 17. DEMOLISHED!
4
at & SeBS
~ fe iS”)
SPE A fA
it
hl Ge ox ~=
i
15. TRAILER 18. NO. GE “ So
16. OVERTURNED 19. OTHI +L fs of Fepairs to any on@ vehicle will be mi yan $1000.
C Sia re —10— Oo nable:to’ Determine ‘es [No
Reference Marker | Coordinates (if available)
Latitude/Northing:
Place Where Accident
Gounty
ms
Deere 1
—ECiy GB Village 0 Town of ROCKVILLE CENTER, VILLAGE OF —
Road on which accident occured CEDAR AVE 2
(Route Number
or Sirest Name)
at 1) intersecting
street_ HEMPSTEAD AVE.
Longitude/Easting: ON os
(Route Number
or Sirest Nama)
or 2) O& OW of
{Milspost, Nearest intersecting Route Number or Stet Name)
Accident Description/Officer’s Notes
stop sign, when MV1 made a wide tum onto Cedar Ave and collided with the front of his vehicle.
Operator of MV2 transported to Mount Sinai South Nassau Hospital by Northwell Ambulance
4468 for
further evaluation. Aided # RC-00791-22.
8 410 44 12 43 44 15 4617 BY TO 18 Names of all involved __Dats
of Death Only _
|Officer’s Rank pro Bee Pom Badge/ID No. [NCIC No. [Precin (Station/Beat/| Reviewing
Troop/Zone | Sector ‘Officer
[Date/Time Reviewed
™° M BONCORE 464 02909 | LRC 1 CLARK, D 04/29/2022 17:36
This is to certify that this document is a true and complete copy of a record on lad TE redder”
PS
file in the New York State Department of Motor Vehicles, Albany, New York. COMMISSIONER OF MOTOR VEHICLES,
INDEX NO. 607676/2023
NYWBGER1 BOC. NO. 29 RECEIVED NYSCEF: 12/28/2023
No Accident Diagram Available
This is to certify that this document is a true and complete copy of a record on lard TF Pdnsdor””
file in the New York State Department of Motor Vehicles, Albany, New York. COMMISSIONER OF MOTOR VEHICLES
Document Filed Date
December 28, 2023
Case Filing Date
May 12, 2023
Category
Torts - Motor Vehicle
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
INDEX NO. 607676/2023 NYSCEF DOC. NO. 29 RECEIVED NYSCEF: 12/28/2023 Exhibit C iA AU OUN WV INDEX NO. 607676/20: 10 NY¥SEER 1.AGE Tek 7 2reee New York State ‘of Motor Vehicles RECEIVED NYSCEF: 12/28/2923 POLICE ACCIDENT REPORT MY-104A (6/04) 18 GKRCI5FD98KQ oO a rs 7 DMV COPY (Accident Day of Week Miltary Time No. of No. injured’ No. Killed] poe ‘atScone[] | Lett Scene] Police Photos 20 ‘Month/Day, ee - 29 2022 FRIDAY 15:25 1 0 [Accident Reconstructed C1 O | Gives Ono VEHICLE 1 VEHICLE 2 OBSICYCUST [J] PEDESTRIAN [J OTHER PEDESTRIAN VEHICLE1- License ID Number _ 472976078 OfLic, | VEHICLE 2 - Driver IDNumber 467102777 Pay a i eran iene, OSWALD, MICHAEL EDWARD DriverName - exactly pepihtad on tesnee ELLIS, ROBIN D [Address (Inciuxta Number & Siroa!) "ABE NO. | Address (include Number & Streat) ‘Apt. No. 1966 JACKSON AVE 316 BALDWIN RD FL 1 ‘or Town EAFORD NY 117830000 ‘STEAD 115500000 Unlicensed No.of ‘Sex Unlicensed No.of Occupants Property: 3 1839 o Damaged C1) 17 1975 M Oeneetts Damaged Name-exactly as printed on registration ‘Name-exactly as printed on registration 23 [tee]2” [ie |Datoof ROCKVILLE, CENTRE V Morin | ay ] Yeo | eltis, shernice [Ackiress (Incluxa Numbor & Siroat) [Apt No. | Haz. Released | Address (include Number & Streat) [Apt No. [Haz 4 | Po BOX 950 316 BALDWIN RD FL 1 Mat. ma i 1 ROCKVILLE CENTRE HEMPSTEAD NY 115500000 Plata Number [State of Reg.| Vehicle Year & Make [state of Reg. |Vehicie Year & Make (Vehice Type ins. Code AY8768 NY 2016 cuey [BUS SS9T NJ 2013 BMW SUBN 733 ff 1 Number(s) ee é SSF EX Violation Bection(s) ps. 25 ‘Check if Involved vehici "| Check ifinvotved it describes the accident, or draw your own more than 96 Inches wide; \\ Sioa inge napc N er. the vehicles. 1 more than 34 feet 1 operated with an overweight permit; ‘Ernore naira tet ae 24s 5G Pawo Right Tum [Head On 1 operated with an over permit. \hail oper Ove permit >< VEHICLE 1 DAMAGE CODES: 4 ace a uh ‘Sideswipe Box 1 - Point of Impact Box 1 Point of impact Nie (opposite direction) 1 4 Se ines: [ACCIDENT DIAG! Enter up to three more 3 mow i a ace 4% a7 [Vehicle By Nee tS To Petters ae is (0 accident | diagram V4 VEHICLE DAMAGE CODING: 5 f | 4-13. SEE DIAGRAM ON RIGHT. as (i 44, UNDERCARRIAGE 417. DEMOLISHED. —" she 15. TRAILER 18. NO DAMAGE 16. OVERTURNED 19. OTHI Of iépairs to any aca be yan $1000. 7 DiUsieiown/Unabie to Determine es__CONo Reference Marker | Coordinates (available) _ Were Accidr aS bh Latitude/Northing: Ociy G Vilage O Town of ROCKVILLE CENTER, VILLAGE OF Road on which accident ocourred CEDAR AVE (Route Number or Street Namo) at 1) intersecting street_ HEMPSTEAD AVE (Route Number or Street Name) or2) Oe OW of ‘uliopost, Nearest intersecting Route Number or Steot Name) Accident Description/Officer’s Notes Operator of MV 1 states he was turning right from northbound Hempstead Ave onto eastbound Cedar Ave. Operator of MY1 states that due to the large size of his vehicle, he had to make a wide turn, causingthe front end of his vehicle to enter the oncoming lane, where he collided with MV2. ant Operator of MV2 states he was driving westbound on Cedar Ave and slowing down while approaching the 8 2 410 44 12 413 44 45 16 47_ BY TO 18 Date of Only. ajOl 1 4 1 162 M = OSWALD, MICHAEL EDWARD Bj02 1 4 1 46 iM. 12 6 4468 2911 ELLIS, ROBIN D cf0l 6 4 1 [92 iF iS HODGINS, MARIA J pj 01 4 4 1 81 F E YOUNG, BEATRICE K E F |Officer’s Rank land Signature. pro Ger Pom Badge/ID No. NCIG No. |Preci Troop/Zone | Sector ‘Station/Beat/ Reviewing Officer [Date/Time Reviewed lin Full M BONCORE 464 02909 | LRC CLARK,D (04/29/2022 17:36 This is to certify that this document is a true and complete copy of a record on lade SF reedln* OS filein the New York State Department of Motor Vehicles, Albany, New York. COMMISSIONER OF MOTOR VEHICLES a =: INDEX NO. 607676/2023 NSE Qo. 27 — Now York State Department of Motor Vehicles RECEIVED NYSCEF: 12/28/ g 3 POLICE ACCIDENT REPORT MV-104A (6/04) GKRCISFD98KQ Om 1) tit ee A DMV COPY 7 Accident Date. Day of Waek Miltary Time No. Injured . Nehies No. Killed] ‘ot soneinvestigatedat Soane [] | “8! Soene | Police Photos re Tee 04 29 “9022 FRIDAY 15:25 2 1 Accident Reconstructed CI o Elves ONo VEHICLE 1 OD VEHICLE 2 OUBICYCUST [J PEDESTRIAN [1] OTHER PEDESTRIAN VEHICLE 1- Driver [Stale of Lic. [| VEHICLE 2 - Driver [State of Lic. License IO Number Ucense 1D Number aT Driver Name -exactly Driver Name - exactly as printed on license as printed on ficense [Address (Inciuxto Number & Strout) Api. NO. | Address (include Numbor & Siroaty “Apt. No. Gily oF Town Zip Code (City or Town Zip Code Uniicensed No.of Unlicensed : penn | Oa | vow] ‘Occupants Fey, af | ==] Occupants — PEL Boras Name-exactly as printed on registration Name-exactly as printed on registration Day Year [Ackiross (Incluxia Numbor & Siro!) ‘Apt No. | Haz. Released || Address (includa Numbar & Streat) JApt. No. [Haz. Mat. o City oF Town ‘State Zip Code. ‘Cy ok Town State Zip Code. a \) Plate Number State of Reg. | Vehicle Year & Make Vehicle Type [State of Reg. |Vehicie Year & Make Vehicle Type ins. Code mus eo {E BD TicketiArrast Number(s) @ nat Violation Bection(s) ji. ip Salat | ‘Cheok if involved vehicle Is: [72 ‘Winvolved sai {that it describes the accident, or draw your own Cl more than 96 Inches wide; re er.the vehicles. D1 more than 34 feet long; ‘i \ ‘Angie [Right Tum [Head On Cl operated with an overweightpermi 1 operated with an overdimension permit. \ er >< VEHICLE 1 DAMAGE CODES a sity ‘Sideswipe Box 1 - Point of Impact Box 1)" a intof pact a Tete iretlon) MhAM (opposite direction) it “7 Box 2 - Most Damage Box 2 Damege.— Enter up to three more Damage. 3 ‘ ps i i ae [Vehicle By ; oF [Towed ey #4 Bt To a oie pt diagram VEHICLE DAMAGE CODING: Wy I ley t iq 413. SEE DIAGRAM ON RIGHT. 44. UNDERCARRIAGE 17. DEMOLISHED! 4 at & SeBS ~ fe iS”) SPE A fA it hl Ge ox ~= i 15. TRAILER 18. NO. GE “ So 16. OVERTURNED 19. OTHI +L fs of Fepairs to any on@ vehicle will be mi yan $1000. C Sia re —10— Oo nable:to’ Determine ‘es [No Reference Marker | Coordinates (if available) Latitude/Northing: Place Where Accident Gounty ms Deere 1 —ECiy GB Village 0 Town of ROCKVILLE CENTER, VILLAGE OF — Road on which accident occured CEDAR AVE 2 (Route Number or Sirest Name) at 1) intersecting street_ HEMPSTEAD AVE. Longitude/Easting: ON os (Route Number or Sirest Nama) or 2) O& OW of {Milspost, Nearest intersecting Route Number or Stet Name) Accident Description/Officer’s Notes stop sign, when MV1 made a wide tum onto Cedar Ave and collided with the front of his vehicle. Operator of MV2 transported to Mount Sinai South Nassau Hospital by Northwell Ambulance 4468 for further evaluation. Aided # RC-00791-22. 8 410 44 12 43 44 15 4617 BY TO 18 Names of all involved __Dats of Death Only _ |Officer’s Rank pro Bee Pom Badge/ID No. [NCIC No. [Precin (Station/Beat/| Reviewing Troop/Zone | Sector ‘Officer [Date/Time Reviewed ™° M BONCORE 464 02909 | LRC 1 CLARK, D 04/29/2022 17:36 This is to certify that this document is a true and complete copy of a record on lad TE redder” PS file in the New York State Department of Motor Vehicles, Albany, New York. COMMISSIONER OF MOTOR VEHICLES, INDEX NO. 607676/2023 NYWBGER1 BOC. NO. 29 RECEIVED NYSCEF: 12/28/2023 No Accident Diagram Available This is to certify that this document is a true and complete copy of a record on lard TF Pdnsdor”” file in the New York State Department of Motor Vehicles, Albany, New York. COMMISSIONER OF MOTOR VEHICLES