On June 14, 2024 a
Answer
was filed
involving a dispute between
Workers' Compensation Board Of The State Of New York,
and
Momentos Grill Bar & Restaurant Corp,
for Other Matters - Workers Comp App for Judgment
in the District Court of Suffolk County.
Preview
FILED: SUFFOLK COUNTY CLERK 06/14/2024 02:57 PM INDEX NO. 614700/2024
(525)16727755-1
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 06/14/2024
SUPREME
COURTOF THESTATEOF NEWYORK, COUNTYOFSUFFOLK
WORKERS'COMPENSATION
BOARDOF THÉSTATEOF NEWYORK,:
Plaintiff,
-against-
MOMENTOS
GRILL BAR& RESTAURANTCORP
Defendant(s)
:
AR AEON
OF
REGULARITY
X
The undersigned, an Workers'
attorney the office of the
in 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 based upon a review of the which Workers'
is file is maintained by the 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 madean assessment/award in the sum of $21,000.00, 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 chair's
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 $21,000.00 due and payable.
WHEREFORE,it is respectfully requested that judgment be entered against the Defendant(s) herein in
the sum stated as remaining due and payable.
Dated: / t day of -02 .
Scott Caruso, Esq.
C-45.1 4/2007
(525)16727755-1
1 of 3
FILED: SUFFOLK COUNTY CLERK 06/14/2024 02:57 PM INDEX NO. 614700/2024
(526)16727757-1
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 06/14/2024
SUPREME
COURTOF THE STATEOF NEWYORK,COUNTYOFSUFFOLK
X
WORKERS'COMPENSATIONBOARDOFTHE
STATEOF NEWYORK,:
Plaintiff,
-against-
:
MOMENTOS
GRILL BAR & RESTAURANTCORP :
AFFIRMATION
Defendant(s) :
OF .
NON-PAYMENT
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 based upon a review of the Workers'
is file which is maintained by the Compensation
Board in its regular course of business.
I am familiar with the status of payment in this matter. The award/penalty/assessment/demand for
deposit of security madeagainst the defendant(s) in the amount of $21,000.00 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 $21,000.00.
Dated: day of
Scott Caruso, Esq.
C-45.45 1/2009
(526)16727757-1
.
2 of 3
FILED: SUFFOLK COUNTY CLERK 06/14/2024 02:57 PM INDEX NO. 614700/2024
(527)16727759-1
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 06/14/2024
STATEOF NEWYORK
WORKERS'
NEW Workers' COMPENSATIONBOARD THIS AGENCY EMPLOYSANDSERVES
E Compensation JUDGMENT
UNIT PEOPLEWITHDISABILITIES WITHOUT
Board 328 STATESTREET DISCRIMINATION.
SCHENECTADY,NY 12305-2318
866-298-7830
MOMENTOS GRILL BAR& RESTAURANT
CORP WCBEMPLOYER
#: 3150090
22 LINDEN ST
UIER #: 54-81120
SELDENNY11784-2802
FEIN/SS #: *****6098
It is hereby certified that this is a true
and correct copy of the original as filed
with e Workers' Compensation Board
.... . .. ... ................... ...........................
*
DATE: 04/30/2024
FINAL NOTICE JC t f ed on ...............
Non-Compliance
Item Description Dates Accident Date Balance Due
2 023W0020757 Failure to Carry Workers' Comp Ins 02/27/2023-04/21/2024 $21,000.00
Total Balance Due $21,000.00
*
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.
PAYMENTINSTRUCTIONS
To make online payments e-mail Billing@wcb.ny.gov OR
Inorder to insure prompt credit of your payment, complete the following with the
Date, Number and Amount of your check and return it, along with your payment to:
NYSWORKERS'COMPENSATION
BOARD
POBOX5530
BINGHAMTON,NY 13902-5530
...--........-----..........________Please...deta_ch..and_refgm.bqttggt..p_ortion with_y_our pay_ment.
MAKECHECKSPAYABLETO"COMMISSIONEROFTAXATIONANDFINANCE".
PLEASEINCLUDEYOURWCBEMPLOYERNUMBER ONYOURCHECK.
Employer MOMENTOS CORP
GRILL BAR& RESTAURANT WCBEmployer # 3150090
Customer ID #
Check Date Check
Check #
Amount
C-45.37 10/2023 Page 1 of 2
(527)16727759-1
3 of 3
Document Filed Date
June 14, 2024
Case Filing Date
June 14, 2024
Category
Other Matters - Workers Comp App for Judgment
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FILED: SUFFOLK COUNTY CLERK 06/14/2024 02:57 PM INDEX NO. 614700/2024 (525)16727755-1 NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 06/14/2024 SUPREME COURTOF THESTATEOF NEWYORK, COUNTYOFSUFFOLK WORKERS'COMPENSATION BOARDOF THÉSTATEOF NEWYORK,: Plaintiff, -against- MOMENTOS GRILL BAR& RESTAURANTCORP Defendant(s) : AR AEON OF REGULARITY X The undersigned, an Workers' attorney the office of the in 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 based upon a review of the which Workers' is file is maintained by the 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 madean assessment/award in the sum of $21,000.00, 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 chair's 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 $21,000.00 due and payable. WHEREFORE,it is respectfully requested that judgment be entered against the Defendant(s) herein in the sum stated as remaining due and payable. Dated: / t day of -02 . Scott Caruso, Esq. C-45.1 4/2007 (525)16727755-1 1 of 3 FILED: SUFFOLK COUNTY CLERK 06/14/2024 02:57 PM INDEX NO. 614700/2024 (526)16727757-1 NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 06/14/2024 SUPREME COURTOF THE STATEOF NEWYORK,COUNTYOFSUFFOLK X WORKERS'COMPENSATIONBOARDOFTHE STATEOF NEWYORK,: Plaintiff, -against- : MOMENTOS GRILL BAR & RESTAURANTCORP : AFFIRMATION Defendant(s) : OF . NON-PAYMENT 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 based upon a review of the Workers' is file which is maintained by the Compensation Board in its regular course of business. I am familiar with the status of payment in this matter. The award/penalty/assessment/demand for deposit of security madeagainst the defendant(s) in the amount of $21,000.00 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 $21,000.00. Dated: day of Scott Caruso, Esq. C-45.45 1/2009 (526)16727757-1 . 2 of 3 FILED: SUFFOLK COUNTY CLERK 06/14/2024 02:57 PM INDEX NO. 614700/2024 (527)16727759-1 NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 06/14/2024 STATEOF NEWYORK WORKERS' NEW Workers' COMPENSATIONBOARD THIS AGENCY EMPLOYSANDSERVES E Compensation JUDGMENT UNIT PEOPLEWITHDISABILITIES WITHOUT Board 328 STATESTREET DISCRIMINATION. SCHENECTADY,NY 12305-2318 866-298-7830 MOMENTOS GRILL BAR& RESTAURANT CORP WCBEMPLOYER #: 3150090 22 LINDEN ST UIER #: 54-81120 SELDENNY11784-2802 FEIN/SS #: *****6098 It is hereby certified that this is a true and correct copy of the original as filed with e Workers' Compensation Board .... . .. ... ................... ........................... * DATE: 04/30/2024 FINAL NOTICE JC t f ed on ............... Non-Compliance Item Description Dates Accident Date Balance Due 2 023W0020757 Failure to Carry Workers' Comp Ins 02/27/2023-04/21/2024 $21,000.00 Total Balance Due $21,000.00 * 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. PAYMENTINSTRUCTIONS To make online payments e-mail Billing@wcb.ny.gov OR Inorder to insure prompt credit of your payment, complete the following with the Date, Number and Amount of your check and return it, along with your payment to: NYSWORKERS'COMPENSATION BOARD POBOX5530 BINGHAMTON,NY 13902-5530 ...--........-----..........________Please...deta_ch..and_refgm.bqttggt..p_ortion with_y_our pay_ment. MAKECHECKSPAYABLETO"COMMISSIONEROFTAXATIONANDFINANCE". PLEASEINCLUDEYOURWCBEMPLOYERNUMBER ONYOURCHECK. Employer MOMENTOS CORP GRILL BAR& RESTAURANT WCBEmployer # 3150090 Customer ID # Check Date Check Check # Amount C-45.37 10/2023 Page 1 of 2 (527)16727759-1 3 of 3