Preview
(FILED: QUEENS COUNTY CLERK 1271772012) INDEX NO. 901129/2012
NYSCEF DOC. NO. 1 RECEIVED NYSCEF 12/07/2012
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF QUEENS
x
WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, ©
Plaintiff,
-against-
MAMITA'S RESTAURANT LLC; ELEDNORA RODRIGUEZ, PRESIDENT :
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 affirmation is based upon a review of the file which is maintained by the Workers' Compensation
Board in its regular course of business.
| am familiar with the status of payment in this matter. The award/penalty/assessment/demand for
deposit of security made against the defendant(s) in the amount of $4,000.00 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 $4,000.00.
Dated 29th _ day of October 2012
Si
James R. McGinn, Esq.
Judgment Unit
C-45.45E 1/2009
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF QUEENS
x
WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, ©
Plaintiff,
-against-
MAMITA'S RESTAURANT LLC; ELEDNORA RODRIGUEZ, PRESIDENT :
AFFIRMATION
Defendant(s)
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 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 $4,000.00, 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 $4,000.00 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: _ 29th day of October 2012
SI
James R. McGinn, Esq.
Judgment Unit
C-45.1E 6/2007
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES.
L JUDGMENT UNIT PEOPLE WITH DISABILITIES WITHOUT
‘<
te 328 STATE STREET DISCRIMINATION
SCHENECTADY, NY 12305-2318,
weLsioe 866-298-7830
ELEDNORA RODRIGUEZ, PRESIDENT WCB EMPLOYER #: 2598598
MAMITA'S RESTAURANT LLC VIER #. 49-66773
4043 JUNCTION BLVD
FEIN/SS #: HOBO)
CORONA NY 11368-2121
Itis hereby certified that this is a true
and correct copy of the ori inal as filed
with the Workers’ Compensation Board
Sf
James R. MoGi , Esq.
DATE: 10/29/2012 FINAL NOTICE * Judgment Unit
Certified on, 10/292
Non-Compliance
Item Description Dates Accident Date] Balance Due
j2012W0001622 Failure to Carry Workers! Comp Ins 10/31/2011-11/27/2011 $4,000.00
|rotal Balance Due $4,000.00
* 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.
In order 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:
WORKERS' COMPENSATION BOARD.
FINANCE OFFICE
328 STATE STREET, SCHENECTADY, NY 12305-2318
Please detach and return bottom portion with your payment.
_ _
MAKE CHECKS PAYABLE TO “UNINSURED EMPLOYERS FUND”.
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
Employer | MAMITA'S RESTAURANT LLC WCB Employer# | 2598598
Customer ID # 1667273
Check
Check Date Check #
Amount
C-45.37 5/2004 Page 1 of 2
Non-Compliance
Item Description Dates Accident Date | Balance Due
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
—
Mail payment along with this form to:
WORKERS' COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET
SCHENECTADY, NY 12305-2318
C-45.37 5/2004 Page
2 of 2
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF QUEENS
x
WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, © JUDGMENT
Plaintiff,
-against- EMP# 2698598
JUD# 21140177
MAMITA'S RESTAURANT LLC; ELEDNORA RODRIGUEZ, PRESIDENT :
Defendant(s) INDEX #
FILING DT:
x
By order of the Chair of the Workers' Compensation Board of the State of New York, demand for the
payment of the sum of $4,000.00, representing Awards and Penalties having been made against the
above captioned Defendant(s), after due notice, having defaulted in payment thereof, except the sum of
$0.00 leaving $4,000.00 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, attorney 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; 4043 JUNCTION BLVD, CORONA,
NY 11368-2121; 4043 JUNCTION BLVD, CORONA, NY 11368-2121 , respectively; the sum of
$4,000.00, and the Plaintiff have execution therefore.
Judgment signed this: day of
Clerk
James R. McGinn, Esq.
Attorney for Plaintiff
Workers' Compensation Board
328 State St.
Schenectady, NY 12305
C-45 6/2007
Preview
(FILED: QUEENS COUNTY CLERK 1271772012) INDEX NO. 901129/2012 NYSCEF DOC. NO. 1 RECEIVED NYSCEF 12/07/2012 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF QUEENS x WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, © Plaintiff, -against- MAMITA'S RESTAURANT LLC; ELEDNORA RODRIGUEZ, PRESIDENT : 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 affirmation is based upon a review of the file which is maintained by the Workers' Compensation Board in its regular course of business. | am familiar with the status of payment in this matter. The award/penalty/assessment/demand for deposit of security made against the defendant(s) in the amount of $4,000.00 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 $4,000.00. Dated 29th _ day of October 2012 Si James R. McGinn, Esq. Judgment Unit C-45.45E 1/2009 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF QUEENS x WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, © Plaintiff, -against- MAMITA'S RESTAURANT LLC; ELEDNORA RODRIGUEZ, PRESIDENT : AFFIRMATION Defendant(s) 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 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 $4,000.00, 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 $4,000.00 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: _ 29th day of October 2012 SI James R. McGinn, Esq. Judgment Unit C-45.1E 6/2007 STATE OF NEW YORK WORKERS' COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES. L JUDGMENT UNIT PEOPLE WITH DISABILITIES WITHOUT ‘< te 328 STATE STREET DISCRIMINATION SCHENECTADY, NY 12305-2318, weLsioe 866-298-7830 ELEDNORA RODRIGUEZ, PRESIDENT WCB EMPLOYER #: 2598598 MAMITA'S RESTAURANT LLC VIER #. 49-66773 4043 JUNCTION BLVD FEIN/SS #: HOBO) CORONA NY 11368-2121 Itis hereby certified that this is a true and correct copy of the ori inal as filed with the Workers’ Compensation Board Sf James R. MoGi , Esq. DATE: 10/29/2012 FINAL NOTICE * Judgment Unit Certified on, 10/292 Non-Compliance Item Description Dates Accident Date] Balance Due j2012W0001622 Failure to Carry Workers! Comp Ins 10/31/2011-11/27/2011 $4,000.00 |rotal Balance Due $4,000.00 * 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. In order 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: WORKERS' COMPENSATION BOARD. FINANCE OFFICE 328 STATE STREET, SCHENECTADY, NY 12305-2318 Please detach and return bottom portion with your payment. _ _ MAKE CHECKS PAYABLE TO “UNINSURED EMPLOYERS FUND”. PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. Employer | MAMITA'S RESTAURANT LLC WCB Employer# | 2598598 Customer ID # 1667273 Check Check Date Check # Amount C-45.37 5/2004 Page 1 of 2 Non-Compliance Item Description Dates Accident Date | Balance Due MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". — Mail payment along with this form to: WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET SCHENECTADY, NY 12305-2318 C-45.37 5/2004 Page 2 of 2 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF QUEENS x WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, © JUDGMENT Plaintiff, -against- EMP# 2698598 JUD# 21140177 MAMITA'S RESTAURANT LLC; ELEDNORA RODRIGUEZ, PRESIDENT : Defendant(s) INDEX # FILING DT: x By order of the Chair of the Workers' Compensation Board of the State of New York, demand for the payment of the sum of $4,000.00, representing Awards and Penalties having been made against the above captioned Defendant(s), after due notice, having defaulted in payment thereof, except the sum of $0.00 leaving $4,000.00 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, attorney 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; 4043 JUNCTION BLVD, CORONA, NY 11368-2121; 4043 JUNCTION BLVD, CORONA, NY 11368-2121 , respectively; the sum of $4,000.00, and the Plaintiff have execution therefore. Judgment signed this: day of Clerk James R. McGinn, Esq. Attorney for Plaintiff Workers' Compensation Board 328 State St. Schenectady, NY 12305 C-45 6/2007