Exhibit,Appendix: Nicole Pulaski As Proposed Administrator Of the Estate of Luis A. Garcia v. Nassau Operating Company, Llc d/b/a Nassau Rehabilitation and Nursing Center, Bent Philipson, Joel Leifer, Esther Farkovits, John And Jane Roes 1-10, John And Jane Doe Physicians 1-10, Richard And Jane Roe Nurses, Technicians, Paramedical, Cnas And Employees 1-30, Abc Corporation, Abc Partnership

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                                FILED: NASSAU COUNTY CLERK 01/18/2024 07:24 PM         INDEX NO. 615347/2023
NYSCEF DOC. NO. 32                               RECEIVED NYSCEF: 01/18/2024




                         EXHIBIT 1
FILED: NASSAU COUNTY CLERK 01/18/2024 07:24 PM                                                          INDEX NO. 615347/2023
NYSCEF DOC. NO. 32                                                                              RECEIVED NYSCEF: 01/18/2024

  AFFIDAVIT
  The unclersigned, being first duly srvorn, deposes and says:

         l.    That am the                                                        of
                                                            who died on or about the      2?rLo       ay   of


         1.    That no personal representative or executor has been appointed for the decedent's estate in this state or elsewhere
               and no application for such an appointrnent is pending in this state or elsewhere.


       2.      That this affidavit is made in support of the undersigned's request for the release of medical and/or prescription
               records.


  Further, your affiant sayeth naught.

  Date   the              I                     day   of                          ,ro4
  Signature:
  Printed Name:


  ACKNOWLEDGEMENT
  STATE OF                Nj,!"rt      4nfF-
  COLINTY/TOWNSHIP OF

  On          this             d                &-ll-L,^t&U, 202 before me the
                                             ,personally                                           unclersignecl personally
  a                                                  known   or proved
                                                             to be     me   to     on the basis of satisfactory eviclence to bc
  the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same
  in his/her capacity, and that by his/her signature on the instrument, the individual or the person who acted on behalf of
  the individual, execu      the instrument and such individ       made      cha ppearance before the undersigned in the
  County/Township                            in the State of



                      otary
                                                                                   YorK




   CNI{: Garcia,Luis - 52725