Preview
FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK,
Plaintiff,
-against- :
:
DESIGN YOURSELF STRONG LLC :
AFFIRMATION
Defendant(s) :
OF
NON-PAYMENT
:
:
:
:
X
Workers'
The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew
York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon
information and belief
Workers'
This affirmationisbased upon a review of the file
which ismaintained by the Compensation
Board initsregular course of business.
I am familiarwith the status of payment in thismatter. The award/penalty/assessment/demand for
deposit of security made against the defendant(s) in theamount of $9,500.00 is in default,
as more than
thirtydays have elapsed since the demand upon the defendant(s) herein for payment. No payment has
been received nor has the aforesaid securitybeen deposited incompliance with said deiñand todate,
except the sum of $153.51, leaving due and payble the sum of $9,346.49.
Dated: 10th day of Mav , 2021 .
S/
James R. McGinn, Esq.
Judgment Unit
C-45.45E 1/2009
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NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
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FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK,
Plaintiff,
-against- :
:
DESIGN YOURSELF STRONG LLC :
AFFIRMATION
Defendant(s) :
OF
REGULARITY
:
:
:
:
X
Workers'
The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew
York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon
information and belief
Workers'
This affirmationisbased upon a review of the file
which ismaintained by the Compensation
Board initsregular course of business.
Workers'
The Compensation Board of the State of New York, inaccordance with the provisions of the
Workers'
Compensation Law, has made an assessment/award in thesum of $9,500.00, against the
defendant(s). Attached hereto and made a part hereofare certifiedcopies of the Notice of Decision and
Award, and/or a certifiedcopy of the demand fordeposit of security,and/or a certifiedcopy ofthe chair's
order imposing, and the demand for payment of, assessments imposed by the chairpursuant to
Workers'
subdivision five ofsection fifty-twoand/or one hundred thirtyone of the Compensation Law, as
Workers'
required for of
filing judgment per Compensation Law, Section 26 and/or 219. Appeals before
the Board have been exhausted.
No payment of award has been made except $153.51, leaving $9,346.49 due and payable.
W| |EREFORE, it is
respectfullyrequested that judgment be entered against the Defendant(s) herein in
the sum stated as remaining due and payable.
Dated: 10th day of May 2021
S/
James R. McGinn, Esq.
Judgment Unit
C-45.1E 6/2007
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NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
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FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
STATE OF NEW YORK
WORKERS'
NEW Workers' COMPENSATION BOARD THISAGENCYEMPLOYSAND SERVES
JUDGMENT UNIT PEOPLEWITH DISABILITIESWITHOUT
ÏŸZE compensation
328 STATE STREET DISCRIMINATION.
Board
SCHENECTADY, NY 12305-2318
866-298-7830
DESIGN YOURSELF STRONG LLC WCB EMPLOYER #: 3081601
2273 ROUTE 32 UlER #: 53-98170
SAUGERTIES NY 12477-4732
FEIN/SS #: *****3041
It is
hereby that
certified thisis a true
and correct copy ofthe originalas filed
Workers'
with the Campen=tion Board
S/
James R. McGinn, Esq.
deem~" Unit
DATE: 05/10/2021
rartiflori
an n8/10/91
Non-Compliance
Item D6sulipiion Dates Accident Date Balance Due
2019W0017458 Failure to Workers' Ins 12/31/2018-07/08/2019 $9,346.49
Carry Comp
Total Balance Due $9,346.49
*
If payment isnot received iriimediatê|y,
judg ent willbe filedand the employciis subject to seizure
of assets, both business and personal, without further noticefrom the Board.
In orderto insurepron1ptcredit
of your payi ei t, con1plete
thefollowingwiththe
Date, Nun1ber and An1ount of yourcheck and return with
it, along your paynientto.
WORKERS'
COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET, SCHENECTADY, NY 12305-2318
Please detach and return bottom paitõñ with your paymêñt.
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
E pi0ÿóf DESIGN YOURSELF STRONG LLC WCB Employer #
| 3081601
Customer ID #
Check
Check Date Check #
Amount
I
C-45.37 5/2004 Page 1 of 2
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FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
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
6 of 7
FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK, JUDGMENT
Plaintiff,
-against- : EMP# : 3081601
: JUD# : 2121985
DESIGN YOURSELF STRONG LLC :
Defendant(s) : INDEX # :
FILING DT:
:
:
:
X
Workers'
By order of the Chair of the Compensation Board of the Stateof New York, demand forthe
payment of the sum of $9,500.00, representing Awards and Penalties having been made against the
above captioned Defendant(s), afterdue notice,having defaulted inpayment thereof,except the sum of
$153.51 leaving $9,346.49 due and payable.
NOW, upon the certifiedcopies of notices attached hereto,and upon motion ofthe General Counsel of
Workers'
the Compensation Board of the State of New York, attorney for pursuant
Plaintiff, toSection
Workers'
26 of the Compensation Law of the State of New York providing forentry ofjudgment by the
Workers'
County Clerk in event of such default, it is
ADJUDGED, that the Plaintiff, Compensation Board
of the Stateof New York, 328 State Street, Schenectady, NY 12305 does recover from the
above-captioned Defendant(s), whose last known address(es) are; 2273 ROUTE 32, SAUGERTIES, NY
12477-4732, respectively; the sum of $9,346.49, and the Plaintiffhave execution therefore.
Judgment signed this: day of , .
Clerk
James R. McGinn, Esq.
Attorney forPlaintiff
Workers'
Compensation Board
328 State St.
Schenectady, NY 12305
C-45 6/2007
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Preview
FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, Plaintiff, -against- : : DESIGN YOURSELF STRONG LLC : AFFIRMATION Defendant(s) : OF NON-PAYMENT : : : : X Workers' The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon information and belief Workers' This affirmationisbased upon a review of the file which ismaintained by the Compensation Board initsregular course of business. I am familiarwith the status of payment in thismatter. The award/penalty/assessment/demand for deposit of security made against the defendant(s) in theamount of $9,500.00 is in default, as more than thirtydays have elapsed since the demand upon the defendant(s) herein for payment. No payment has been received nor has the aforesaid securitybeen deposited incompliance with said deiñand todate, except the sum of $153.51, leaving due and payble the sum of $9,346.49. Dated: 10th day of Mav , 2021 . S/ James R. McGinn, Esq. Judgment Unit C-45.45E 1/2009 1 of 7 FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 2 of 7 FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, Plaintiff, -against- : : DESIGN YOURSELF STRONG LLC : AFFIRMATION Defendant(s) : OF REGULARITY : : : : X Workers' The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon information and belief Workers' This affirmationisbased upon a review of the file which ismaintained by the Compensation Board initsregular course of business. Workers' The Compensation Board of the State of New York, inaccordance with the provisions of the Workers' Compensation Law, has made an assessment/award in thesum of $9,500.00, against the defendant(s). Attached hereto and made a part hereofare certifiedcopies of the Notice of Decision and Award, and/or a certifiedcopy of the demand fordeposit of security,and/or a certifiedcopy ofthe chair's order imposing, and the demand for payment of, assessments imposed by the chairpursuant to Workers' subdivision five ofsection fifty-twoand/or one hundred thirtyone of the Compensation Law, as Workers' required for of filing judgment per Compensation Law, Section 26 and/or 219. Appeals before the Board have been exhausted. No payment of award has been made except $153.51, leaving $9,346.49 due and payable. W| |EREFORE, it is respectfullyrequested that judgment be entered against the Defendant(s) herein in the sum stated as remaining due and payable. Dated: 10th day of May 2021 S/ James R. McGinn, Esq. Judgment Unit C-45.1E 6/2007 3 of 7 FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 4 of 7 FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 STATE OF NEW YORK WORKERS' NEW Workers' COMPENSATION BOARD THISAGENCYEMPLOYSAND SERVES JUDGMENT UNIT PEOPLEWITH DISABILITIESWITHOUT ÏŸZE compensation 328 STATE STREET DISCRIMINATION. Board SCHENECTADY, NY 12305-2318 866-298-7830 DESIGN YOURSELF STRONG LLC WCB EMPLOYER #: 3081601 2273 ROUTE 32 UlER #: 53-98170 SAUGERTIES NY 12477-4732 FEIN/SS #: *****3041 It is hereby that certified thisis a true and correct copy ofthe originalas filed Workers' with the Campen=tion Board S/ James R. McGinn, Esq. deem~" Unit DATE: 05/10/2021 rartiflori an n8/10/91 Non-Compliance Item D6sulipiion Dates Accident Date Balance Due 2019W0017458 Failure to Workers' Ins 12/31/2018-07/08/2019 $9,346.49 Carry Comp Total Balance Due $9,346.49 * If payment isnot received iriimediatê|y, judg ent willbe filedand the employciis subject to seizure of assets, both business and personal, without further noticefrom the Board. In orderto insurepron1ptcredit of your payi ei t, con1plete thefollowingwiththe Date, Nun1ber and An1ount of yourcheck and return with it, along your paynientto. WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET, SCHENECTADY, NY 12305-2318 Please detach and return bottom paitõñ with your paymêñt. MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. E pi0ÿóf DESIGN YOURSELF STRONG LLC WCB Employer # | 3081601 Customer ID # Check Check Date Check # Amount I C-45.37 5/2004 Page 1 of 2 5 of 7 FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 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 6 of 7 FILED: ULSTER COUNTY CLERK 06/10/2021 12:53 PM INDEX NO. EF2021-1566 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 06/10/2021 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF ULSTER X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, JUDGMENT Plaintiff, -against- : EMP# : 3081601 : JUD# : 2121985 DESIGN YOURSELF STRONG LLC : Defendant(s) : INDEX # : FILING DT: : : : X Workers' By order of the Chair of the Compensation Board of the Stateof New York, demand forthe payment of the sum of $9,500.00, representing Awards and Penalties having been made against the above captioned Defendant(s), afterdue notice,having defaulted inpayment thereof,except the sum of $153.51 leaving $9,346.49 due and payable. NOW, upon the certifiedcopies of notices attached hereto,and upon motion ofthe General Counsel of Workers' the Compensation Board of the State of New York, attorney for pursuant Plaintiff, toSection Workers' 26 of the Compensation Law of the State of New York providing forentry ofjudgment by the Workers' County Clerk in event of such default, it is ADJUDGED, that the Plaintiff, Compensation Board of the Stateof New York, 328 State Street, Schenectady, NY 12305 does recover from the above-captioned Defendant(s), whose last known address(es) are; 2273 ROUTE 32, SAUGERTIES, NY 12477-4732, respectively; the sum of $9,346.49, and the Plaintiffhave execution therefore. Judgment signed this: day of , . Clerk James R. McGinn, Esq. Attorney forPlaintiff Workers' Compensation Board 328 State St. Schenectady, NY 12305 C-45 6/2007 7 of 7