Preview
FILED: BRONX COUNTY CLERK 09/11/2020 05:51 PM INDEX NO. 26901/2020E
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/11/2020
REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,)
Bronx Supreme COURT, COUNTY OF Bronx
Index No: 26901/2020E Date Index Issued: 07/07/2020 For Court Use Only:
CAltMWFFftfilift riper sheet. IAS Entry Date
O. a-j± Okpeseyi
Judge Assigned
-against- Plaintiff(s)/Petitioner(s)
Mcñtc G-E Medical Center
RJIFiled Date
Defenhat)for;,andent(c)
ongbox and specify where indicated.
COMMERCIAL MATRIMONIAL
O Contested
O Business Entity (includes corporat!ens,partnerships, LLCs,LLPs,etc.)
NOTE: If there are children under the age of 18, complete and attach the
Contract MATRIMONDALRJRAddendum (UCS-840M).
O Insurance(where insurance company is a party, except =rb!trat!en) . .
For UncontestedMatnmonial actions, use the Unwmested Divorce RJi(UD-13).
O UCC(includes sales and negotiable instruments)
O Other Commercial(specify):
| TORTS
NOTE: For CommercialDivision sssignment requests pursuant to 22 NYCRR202.70(d),
complete and attach the COMMERCIALDEVISIONRJRADDENDUM (UCS-840C). Asbestos
O Child Victims Act
REAL PROPERTY: Specify how many properties the epp!!cet!enincludes: .
Env~^a-M .
(specify):
O Condemnation Medical,Dental, or Podiatric Malpractice
O Mortgage Foreclosure(specify): O iniueniioi 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 m:!dential property or owner-occupiedcondnminiUm,Completeand O Other ProfessionalMalpractice (specify):
attach the FORECLDSURERJRADDENDUM (UCS-840F). Other Tort (specify): Employment discrimination
Tax Certiorari - Section: Block: Lot:
Tax Foreclosure | SPECIAL PROCEEDINGS
O Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection]
OTHER MATTERS
O CPLRArticle 78 (Body or Officer)
Incorporailus./L:-" O Election Law
O Certificate of .t|:n [see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder
O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law)
O HabeasCorpus O MHLArticle 10 (Sex Offender Confinemant-Initial)
O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review)
O Mechanic'sLien MHLArticle 81 (Guardianship)
O NameChange O Other Mental Hygiene (specify):
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 |nfGrrnationwhere indicated.
YES NO
Hasa summons and complaint or summonswith notice been filed? O If yes, date filed: 07/06R020
Hasa summons and complaint or summonswith notice been served? O If yes, date served: 07/00S020
Is this action/proceeding being filed post-judgment? O If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional info=2tion where indicated.
O Infant's Compromise
O Extreme Risk ProtectionOrder App!!cat!en
O Note of Issue/Certificateof Readiness
O Notice of Medical, Dental, or Podiatric Malpractice Date Issuejoined:
Relief Requested: |udgment - Default Return Date: 10/15R020
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 ForeclosureSettlement Conference
O Writ of HabeasCorpus
O Other (specify):
1 of 2
FILED: BRONX COUNTY CLERK 09/11/2020 05:51 PM INDEX NO. 26901/2020E
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/11/2020
RELATED CASES: List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space
is required, complete and attach the RJI Addendum (UCS-840A).
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).
Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance
Un-
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; 3rd party plaintiff, etc.) email. been joined. carrier, if applicable.
Name: Okpeseyi, O. B.
☐ ADEWALE MOSAKU, LAW OFFICE OF WALE MOSAKU, P.C.,
25 Bond St FL 3rd , Brooklyn, NY 11201, ☒ YES ☐ NO
Role(s): Plaintiff/Petitioner wmosaku@juno.com
Name: Montefiore Medical Center
☒ 440 East Fordham Road, Suite 11, Bronx, NY 10458
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ 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 FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS
ACTION OR PROCEEDING.
Dated: 09/11/2020 ADEWALE AKIM MOSAKU
Signature
2917110 ADEWALE AKIM MOSAKU
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 2
Preview
FILED: BRONX COUNTY CLERK 09/11/2020 05:51 PM INDEX NO. 26901/2020E NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/11/2020 REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,) Bronx Supreme COURT, COUNTY OF Bronx Index No: 26901/2020E Date Index Issued: 07/07/2020 For Court Use Only: CAltMWFFftfilift riper sheet. IAS Entry Date O. a-j± Okpeseyi Judge Assigned -against- Plaintiff(s)/Petitioner(s) Mcñtc G-E Medical Center RJIFiled Date Defenhat)for;,andent(c) ongbox and specify where indicated. COMMERCIAL MATRIMONIAL O Contested O Business Entity (includes corporat!ens,partnerships, LLCs,LLPs,etc.) NOTE: If there are children under the age of 18, complete and attach the Contract MATRIMONDALRJRAddendum (UCS-840M). O Insurance(where insurance company is a party, except =rb!trat!en) . . For UncontestedMatnmonial actions, use the Unwmested Divorce RJi(UD-13). O UCC(includes sales and negotiable instruments) O Other Commercial(specify): | TORTS NOTE: For CommercialDivision sssignment requests pursuant to 22 NYCRR202.70(d), complete and attach the COMMERCIALDEVISIONRJRADDENDUM (UCS-840C). Asbestos O Child Victims Act REAL PROPERTY: Specify how many properties the epp!!cet!enincludes: . Env~^a-M . (specify): O Condemnation Medical,Dental, or Podiatric Malpractice O Mortgage Foreclosure(specify): O iniueniioi 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 m:!dential property or owner-occupiedcondnminiUm,Completeand O Other ProfessionalMalpractice (specify): attach the FORECLDSURERJRADDENDUM (UCS-840F). Other Tort (specify): Employment discrimination Tax Certiorari - Section: Block: Lot: Tax Foreclosure | SPECIAL PROCEEDINGS O Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection] OTHER MATTERS O CPLRArticle 78 (Body or Officer) Incorporailus./L:-" O Election Law O Certificate of .t|:n [see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law) O HabeasCorpus O MHLArticle 10 (Sex Offender Confinemant-Initial) O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review) O Mechanic'sLien MHLArticle 81 (Guardianship) O NameChange O Other Mental Hygiene (specify): 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 |nfGrrnationwhere indicated. YES NO Hasa summons and complaint or summonswith notice been filed? O If yes, date filed: 07/06R020 Hasa summons and complaint or summonswith notice been served? O If yes, date served: 07/00S020 Is this action/proceeding being filed post-judgment? O If yes, judgment date: NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional info=2tion where indicated. O Infant's Compromise O Extreme Risk ProtectionOrder App!!cat!en O Note of Issue/Certificateof Readiness O Notice of Medical, Dental, or Podiatric Malpractice Date Issuejoined: Relief Requested: |udgment - Default Return Date: 10/15R020 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 ForeclosureSettlement Conference O Writ of HabeasCorpus O Other (specify): 1 of 2 FILED: BRONX COUNTY CLERK 09/11/2020 05:51 PM INDEX NO. 26901/2020E NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/11/2020 RELATED CASES: List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space is required, complete and attach the RJI Addendum (UCS-840A). 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). Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Un- 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; 3rd party plaintiff, etc.) email. been joined. carrier, if applicable. Name: Okpeseyi, O. B. ☐ ADEWALE MOSAKU, LAW OFFICE OF WALE MOSAKU, P.C., 25 Bond St FL 3rd , Brooklyn, NY 11201, ☒ YES ☐ NO Role(s): Plaintiff/Petitioner wmosaku@juno.com Name: Montefiore Medical Center ☒ 440 East Fordham Road, Suite 11, Bronx, NY 10458 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ 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 FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. Dated: 09/11/2020 ADEWALE AKIM MOSAKU Signature 2917110 ADEWALE AKIM MOSAKU Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 2