Request for Judicial Intervention: Maria Delgado v. Nelson Rojas

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                                NYSCEF DOC. NO. 4
REQUEST FOR JUDICIAL INTERVENTION

ucs-840 (7/2012)

INDEX NO. 601610/2015
RECEIVED NYSCEF: 07/17/2015

For Court Clerk Use Only:

Supreme COURT, COUNTY OF. Nassau

jf t~“‘C‘SCCOCUGge@ Assigned
mete Pate index sued $e

~ Enter the complete case caption. Do not use et al or et ano. If more space is required, RID
canon attach a caption rider sheet.
IMARIA DELGADO
Plaintiff(s)/Petitioner(s)

~against-
INELSON ROJAS

NATURE OF ACTION OR PROCEEDING:

Check ONE box only and speci

Defendant(s)/Respondent(s)

Where indicated.
COMMERCIAL

O Contested

NOTE: For all Matrimonial actions where the parties have children under
the age of 18, complete and attach the MATRIMONIAL RJI Addendum.

For Uncontested Matrimonial actions, use RJ! form UD-13.

© Asbestos
© Breast Implant
© Environmental:

© Business Entity (including corporations, partnerships, LLCs, etc.)
O contract

© insurance (where insurer is a party, except arbitration)

© UCC (including sales, negotiable instruments)

© Other Commercial:

‘Gpecty)

NOTE: For Commercial Division assignment requests [22 NYCRR §
202.70(d)], complete and attach the COMMERCIAL DIV RJI Addendum.

O Medical, Dental, or Podiatric Malpractice
© Motor Vehicle
© Products Liability:

REAL PROPERTY:
© Condemnation

© Mortgage Foreclosure (specify):
Property Address:

How many properties does the application include?

O Residential — © Commercial

(specify)
© Other Negligence:PREMISES

(spoaiy)
© Other Professional Malpractice:

(@peaity)
O other Tort:

(specify)
OTHER MATTERS

‘Streel Address: Cily State
NOTE: For Mortgage Foreclosure actions involving a one- to four-family,
‘owner-occupied, residential property, or an owner-occupied

condominium, complete and attach the FORECLOSURE RJI Addendum.

2p

© Tax Certiorari - Section: Block: Lot:
© Tax Foreclosure
© other Real Property:

(pect)

© Certificate of Incorporation/Dissolution [see NOTE under Commercial]

SPECIAL PROCEEDINGS

© Emergency Medical Treatment
O Habeas Corpus
© Local Court Appeal
Mechanic's Lien
OName Change
© Pistol! Permit Revocation Hearing
O Sale or Finance of Religious/Not-for-Profit Property

© Other:

© CPLR Article 75 (Arbitration) [see NOTE under Commercial]
O CPLR Article 78 (Body or Officer)

O Election Law

© MHL Article 9.60 (Kendra’s Law)

© MUL Article 10 (Sex Offender Confinement-Initial)

© MHL Article 10 (Sex Offender Confinement-Review)

© MHL Article 81 (Guardianship)

© Other Mental Hygiene:

(Specify) (pea)

© Other Special Proceeding:

(peat)
STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated.
YES | NO

Has a summons and complaint or summons w/notice been filed? © © _ yes, date filed: 03/12/2015
Has a summons and complaint or summons w/notice been served? © O© _ tyes, date served: 04/02/2015
Is this action/proceeding being filed post-judgment? O- ®@® _Ifyes, judgment date:[NATURE OF JUDICIAL INTERVENTION: Check ONE box only AND enter additional information where indicated.
CO Infant's Compromise

O Note of Issue andior Certificate of Readiness

© Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined:

© Notice of Motion Relief Sought:/udgment - Default Return Date: 08/13/2015
O Notice of Petition Relief Sought: Return Date:

O order to Show Cause Relief Sought: Return Date:

© other Ex Parte Application Relief Sought:

© Poor Person Application
© Request for Preliminary Conference
O Residential Mortgage Foreclosure Settlement Conference
© writ of Habeas Corpus
© Other (specify):
List any related actions. For Matrimonial actions, include any related criminal and/or Famil ut iS
BEPALEDICASES! i ealbona cee squreo Goleta ae ited he ROT Adds nal oom Wane DST a
Case Title Index/Case No. Judge (if assigned) Relationship to Iveta Case

PARTIES: For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail address in space Provided
if additional space is required, complete and attach the RJl Addendum.
Attorneys and/or Unrepresented Litigants:
Provide attorney name, firm name, business address, phone number and e-mail
address of all attorneys that have appeared in the case. For unrepresented
litigants, provide address, phone number and e-mail address.

Uns
Rep

Insurance
Carrier(s):

IDELGADO. SS.
Last Name Last Name First Name
MARIA. VINE AND WISS, PLLC
First Name Firm Name
oO mrimany ote:
. 510 HEMPSTEAD TURNPIKE SUITE 206 WESTHEMPSTEAD NewYork — 11552
Plaintiff Street Address City State Zip

Secondary Role (If any):

1 (516) 747-3222 +1 (516) 740-2838
Phone Fax

swiss@lawpllc.com
e-mail

JROJAS.

Last Name Last Name First Name

INELSON
First Name
Primary Role:

Firm Name

Defendant
‘Secondary Role (if any):

city

Last Name

First Name
Primary Role:

‘Secondary Role (if any):

First Name
Firm Name
Strnet Addirass Clty State Zip

Phone Fax e-mail

Last Name
Oo First Name
Primary Role:

‘Secondary Role (if any):

Last Name First Name

Street Address city

Phone Fax | emai

| AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE
BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR unica INTER’ ENTION PREVIOUSLY BEEN FILED IN
THIS ACTION OR PROCEEDING.

hp
Dated: e){C\ / A

A SIGNATURE
SCOTT L. WISS
ATTORNEY REGISTRATION NUMBER. PRINT OR TYPE NAME