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FILED: NASSAU COUNTY CLERK 12/23/2019 01:54 PM INDEX NO. 612911/2019
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 12/23/2019
"CS"
REQUEST FOR JUDICIAL INTERVENTION (rev. utfzwzusw
Nassau Supreme COURT, COUNTY OF Nassau
Index No: 612911/2019 Date Index Issued: 09/18/2019 For Court Use Only:
IAS Entry Date
ICG CAPITAL FUNDING, LLC,
Judge Assigned
-against- Plaintiff(s)/Petitioner(s)
NICOLE SULLIVAN D/B/A GM DESIGN /GM SIGN INC D/B/A GM DESIGN, NICOLE SULLIVAN, JOHN BOURLIER
RJIFiled Date
Defendar.t(shhapondent(s)
COMMERCIAL MATRIMONIAL
O Contested
O BusinessEntity (includes corporations, p;artnerchinc LLCs,LLPs,etc.)
NOTE: if there are children under the age of 18, complete and attach the
Contract MATR1MONDALRJRAddendum (UCS-84OM).
O Insurance(where insurance company is a party, except arbitration) .
For UncontestedMatnmoniai actions, use the UncontestedDivorce RJi(UD-13).
O UCC(includes sales and negotiable instruments)
O Other Commercial(specify):
TORTS
NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d),
complete and attach the COMMERCRALDEV151ON RJRADDENDUM (UCS-84OC). O Asbestos
O Child Victims Act
REAL PROPERTY: Specify how many properties the application includes:
O Environmental (specify):
O Condemnation O Medical,Dental, or Podiatric Malpractice
O Mortgage Foreclosure(specify): O Residential O Commercial O Motor Vehicle
Property Address: O ProductsLiability (specify):
NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner- O Other Negligence(specify):
occupied residential property or owner-occupiedcondominium, compiete and O Other ProfessionalMalpractice (specify):
attach the FORECLOSURERJRADDENDUM (UCS-84OF).
O Other Tort (specify):
O Tax Certiorari - Section: Block: Lot:
SPECIAL PROCEEDINGS
O Tax Foreclosure
O Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection]
OTHER MATTERS
O CPLRArticle 78 (Body or Officer)
O Election Law
O Certificate of Incorporaile- n [see NOTE in COMMERCIALsection] O Extreme Risk ProtectionOrder
O Emergency MedicalTreatment O MHLArticle 9.60 (Kendra's Law)
O HabeasCorpus O MHLArticle 10 (Sex Offender Confinement-initial)
O LocalCourt Appeal O MHLArticle 10 (Sex Offender Confinement-Review)
O Mechanic'sLien O MHLArticle 81 (Guardianship)
O NameChange O Other Mental Hygiene (specify):
O Pistol Permit Revocation Hearing O Other Special Proceeding(specify):
O Saleor Financeof Religious/Not-for-ProfitProperty
O Other (specify):
STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated.
YES NO
Hasa summons and complaint or summonswith notice been filed? O If yes, date filed: ü9iiõilvis
Hasa summons and complaint or summonswith notice been served? O If yes, date served: 09/19/2019
Is this action/proceeding being filed post-judgment? If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional ir.fo=ction where indicated.
O Infant's Compromise
O Extreme Risk ProtectionOrder Application
O Note of Issue/Certificateof Readiness
O Notice of Medical, Dental, or Podiatric Malpractice Date Issuejoined:
Relief Requested: ludgment - Foreclosure& Sale Return Date: C'-fC?SC22
Notice of Motion
Notice of Petition Relief Requested: Return Date:
O
Order to ShowCause Relief Requested: Return Date:
O
Other Ex ParteApplication Relief Requested:
O
O PoorPersonApplication
O Requestfor Preliminary Conference
O ResidentialMortgage ru.m.Iusure Settlement Conference
O Writ of HabeasCorpus
O Other (specify):
1 of 2
FILED: NASSAU COUNTY CLERK 12/23/2019 01:54 PM INDEX NO. 612911/2019
RELATED CASES: List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space
NYSCEF DOC. NO. 12
is required, complete and attach the RJI Addendum (UCS-840A). RECEIVED NYSCEF: 12/23/2019
Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case
PARTIES: For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space
provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A).
Un- Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Carriers
Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant,
caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance
defendant; 3rdparty plaintiff, etC.) email. beenjoined. carrier, if applicable.
Name: ICGCAPITALFUNDING,LLC. DAVIDFOGEL,David Fogel P.C.,1225 FranklinAve Suite 522, Garden City, NY
11530, 5162791420, david@dfogellaw.com 2 YES 0 NO
Role(s):Plaintiff/Petitioner
Name: NICOLESULLIVAN 5991 SW44th Street , Davie , FL 33314
O YES 2 NO
Role(s):Defendant/Respondent
Name: SULLIVAN,NICOLE 5991 SW44th Street , Davie , FL 33314
O YES 2 NO
Role(s):Defendant/Respondent
Name: BOURLIER,
JOHN 5991 SW44th Street , Davie , FL 33314
0 YES 2 NO
Role(s):Defendant/Respondent
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
0 YES 0 NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
0 YES 0 NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
0 YES 0 NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR
PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FORJUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS
ACTION OR PROCEEDING.
Dated: 12/23/2019 DAVID FOGEL
Signature
4876843 DAVID FOGEL
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 2
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FILED: NASSAU COUNTY CLERK 12/23/2019 01:54 PM INDEX NO. 612911/2019 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 12/23/2019 "CS" REQUEST FOR JUDICIAL INTERVENTION (rev. utfzwzusw Nassau Supreme COURT, COUNTY OF Nassau Index No: 612911/2019 Date Index Issued: 09/18/2019 For Court Use Only: IAS Entry Date ICG CAPITAL FUNDING, LLC, Judge Assigned -against- Plaintiff(s)/Petitioner(s) NICOLE SULLIVAN D/B/A GM DESIGN /GM SIGN INC D/B/A GM DESIGN, NICOLE SULLIVAN, JOHN BOURLIER RJIFiled Date Defendar.t(shhapondent(s) COMMERCIAL MATRIMONIAL O Contested O BusinessEntity (includes corporations, p;artnerchinc LLCs,LLPs,etc.) NOTE: if there are children under the age of 18, complete and attach the Contract MATR1MONDALRJRAddendum (UCS-84OM). O Insurance(where insurance company is a party, except arbitration) . For UncontestedMatnmoniai actions, use the UncontestedDivorce RJi(UD-13). O UCC(includes sales and negotiable instruments) O Other Commercial(specify): TORTS NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d), complete and attach the COMMERCRALDEV151ON RJRADDENDUM (UCS-84OC). O Asbestos O Child Victims Act REAL PROPERTY: Specify how many properties the application includes: O Environmental (specify): O Condemnation O Medical,Dental, or Podiatric Malpractice O Mortgage Foreclosure(specify): O Residential O Commercial O Motor Vehicle Property Address: O ProductsLiability (specify): NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner- O Other Negligence(specify): occupied residential property or owner-occupiedcondominium, compiete and O Other ProfessionalMalpractice (specify): attach the FORECLOSURERJRADDENDUM (UCS-84OF). O Other Tort (specify): O Tax Certiorari - Section: Block: Lot: SPECIAL PROCEEDINGS O Tax Foreclosure O Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection] OTHER MATTERS O CPLRArticle 78 (Body or Officer) O Election Law O Certificate of Incorporaile- n [see NOTE in COMMERCIALsection] O Extreme Risk ProtectionOrder O Emergency MedicalTreatment O MHLArticle 9.60 (Kendra's Law) O HabeasCorpus O MHLArticle 10 (Sex Offender Confinement-initial) O LocalCourt Appeal O MHLArticle 10 (Sex Offender Confinement-Review) O Mechanic'sLien O MHLArticle 81 (Guardianship) O NameChange O Other Mental Hygiene (specify): O Pistol Permit Revocation Hearing O Other Special Proceeding(specify): O Saleor Financeof Religious/Not-for-ProfitProperty O Other (specify): STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated. YES NO Hasa summons and complaint or summonswith notice been filed? O If yes, date filed: ü9iiõilvis Hasa summons and complaint or summonswith notice been served? O If yes, date served: 09/19/2019 Is this action/proceeding being filed post-judgment? If yes, judgment date: NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional ir.fo=ction where indicated. O Infant's Compromise O Extreme Risk ProtectionOrder Application O Note of Issue/Certificateof Readiness O Notice of Medical, Dental, or Podiatric Malpractice Date Issuejoined: Relief Requested: ludgment - Foreclosure& Sale Return Date: C'-fC?SC22 Notice of Motion Notice of Petition Relief Requested: Return Date: O Order to ShowCause Relief Requested: Return Date: O Other Ex ParteApplication Relief Requested: O O PoorPersonApplication O Requestfor Preliminary Conference O ResidentialMortgage ru.m.Iusure Settlement Conference O Writ of HabeasCorpus O Other (specify): 1 of 2 FILED: NASSAU COUNTY CLERK 12/23/2019 01:54 PM INDEX NO. 612911/2019 RELATED CASES: List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space NYSCEF DOC. NO. 12 is required, complete and attach the RJI Addendum (UCS-840A). RECEIVED NYSCEF: 12/23/2019 Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case PARTIES: For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Un- Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Carriers Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance defendant; 3rdparty plaintiff, etC.) email. beenjoined. carrier, if applicable. Name: ICGCAPITALFUNDING,LLC. DAVIDFOGEL,David Fogel P.C.,1225 FranklinAve Suite 522, Garden City, NY 11530, 5162791420, david@dfogellaw.com 2 YES 0 NO Role(s):Plaintiff/Petitioner Name: NICOLESULLIVAN 5991 SW44th Street , Davie , FL 33314 O YES 2 NO Role(s):Defendant/Respondent Name: SULLIVAN,NICOLE 5991 SW44th Street , Davie , FL 33314 O YES 2 NO Role(s):Defendant/Respondent Name: BOURLIER, JOHN 5991 SW44th Street , Davie , FL 33314 0 YES 2 NO Role(s):Defendant/Respondent Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: 0 YES 0 NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: 0 YES 0 NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: 0 YES 0 NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FORJUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. Dated: 12/23/2019 DAVID FOGEL Signature 4876843 DAVID FOGEL Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 2