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SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF NEW YORK
x
WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, ©
Plaintiff,
-against-
MASON HARDING
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 $20,750.00 is in default, as more
than ten 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 $20,750.00.
Dated 27th _ day of November 2007
Si
Scott A. Herron, Esq.
Judgment Unit
C-45.45E 6/2007
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF NEW YORK
x
WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, ©
Plaintiff,
-against-
MASON HARDING
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 $20,750.00, 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 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 $20,750.00 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: _ 27th day of November 2007
SI
Scott A. Herron, Esq.
Judgment Unit
C-45.1E 6/2007
STATE OF NEW YORK
WORKERS’ COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES.
JUDGMENT UNIT PEOPLE WITH DISABILITIES WITHOUT
fy 20 PARK STREET DISCRIMINATION.
| ALBANY, NY 12207-1674
866-298-7830
MASON HARDING WCB EMPLOYER #: 2204515
600 5TH AVE VIER #. 05-59119
NEW YORK NY 10020-2302
FEIN/SS #: 134056922
Itis hereby certified that this is a true
and correct copy of the ori inal as filed
with the Workers’ Compensation Board
Sf
Scott A. Herron, Esq.
DATE: 11/13/2007 FINAL NOTICE * Judgment Unit
Certified on 11/27/07
Non-Compliance
Item Description Dates Accident Date | Balance Due
20060138813 Failure to Carry Workers! Comp Ins 12/20/2003-03/31/2006 $20,750.00
Irotal Balance Due $20,750.00}
* 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.
(Continued on reverse)
PAYMENT INSTRUCTIONS
In order to insure prompt credit of your payment, complete the following with the
Date, Number and Amount cf your check and return it, aleng with your payment to:
WORKERS' COMPENSATION BOARD
FINANCE OFFICE - ROOM 301
20 PARK STREET, ALBANY, NY 12207-1674
Please detach and return bottom portion with your payment.
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MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
Employer | MASON HARDING WCB Employer# | 2204515
Customer ID # 1492667
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 - ROOM 301
20 PARK STREET
ALBANY, NY 12207-1674
C-45.37 5/2004 Page
2 of 2
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SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF NEW YORK
x
WORKERS! COMPENSATION BOARD OF THE STATE OF NEW YORK, © JUDGMENT
Plaintiff,
-against- EMP# 2204515
JUD# : 253307
MASON HARDING
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 $20,750.00, 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 $20,750.00 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, 20 Park Street, Albany, NY 12207 does recover from the above-captioned
Defendant(s), whose last known address(es) are; 600 5TH AVE, NEW YORK, NY 10020-2302,
respectively; the sum of $20,750.00, and the Plaintiff have execution therefore.
Judgment signed this: day of
Clerk
Scott A. Herron, Esq.
Attorney for Plaintiff
Workers' Compensation Board
20 Park St.
Albany, NY 12207
C-45 6/2007