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DOCKET NO.: LLI-CV16-6014318-S
DEUTSCHE BANK NATIONAL TRUST COMPANY, AS
: SUPERIOR COURT
“FRUSFEE FOR SECURITIZED ASSET BACKED
RECEIVABLES LLC TRUST 2007-BR4, MORTGAGE PASS-
THROUGH CERTIFICATES, SERIES 2007-BR4
Vv.
AMY S. POLLEY A/K/A AMY POLLEY ALSO KNOWN AS.
AMY S. MACHUGA, ET AL.
: JUDICIAL DISTRICT OF
> LITCHFIELD
: AT LITCHFIELD
: JUNE 23, 2017
REQUEST FOR LEAVE TO AMEND SUMMONS
Pursuant to Section 10-60(a)(3) of the Connecticut Rules of Court, the Plaintiff hereby requests
leave of the Court to amend its Summons Civil Form JD-CV-| to reflect the actual location where service
of process was made pursuant to the Marshal Return of Service. Attached hereto is the Amended
Summons-Civil Form JD-CV-1.
ORAL ARGUMENT NOT REQUESTED
TESTIMONY NOT REQUIRED
File: 002334F01a WHEREFORE, the plaintiff moves that the-Court-correct-the Summons -to reflect the-actual
location where service of process was made.
Hartford, CT 06120 '
860-808-0606
Its Attorneys
Juris No. 101589
File: 002334F01ORDER
The foregoing Motion having been presented to the Court, after hearing had, it is hereby
ORDERED:
GRANTED/DENIED
BY THE COURT
Judge/Clerk
File: 002334F01CERTIFICATION
——_ Hhereby-certifythat.a-copy-ofthe abeve-was-mailed-or electronically-delivered-onJune-237204¢-——————--
to all counsel and self-represented parties of record and that written consent for electronic delivery was
received from all counsel and self-represented parties of record who were electronically served:
Amy S. Polley
146 High Street
Torrington, CT 06790
State of Connecticut, Department of Revenue Service
450 Columbus Boulevard, Suite 1
Hartford, CT 06103
The Waterbury Hospital
64 Robbins Street
Waterbury, CT 06708
Maletta Pfeiffer & Associates, LLC
30 Peck Road
Torrington, CT 06790
' a
Mae Reston
PURSUANT TO FEDERAL LAW, THIS LAW FIRM IS A DEBT
COLLECTOR. WE ARE ATTEMPTING TO COLLECT A DEBT AND ANY
INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
HOWEVER, IF YOU ARE IN BANKRUPTCY OR RECEIVED A
BANKRUPTCY DISCHARGE OF THIS DEBT, THIS COMMUNICATION IS
NOT AN ATTEMPT TO COLLECT THE DEBT AGAINST YOU
PERSONALLY, BUT IS NOTICE OF A POSSIBLE ENFORCEMENT OF THE
LIEN AGAINST THE COLLATERAL PROPERTY.
File: 002334FO1SUMMONS - CIVIL
JD-CV-1 Rev, 446 STATE OF CONNECTICUT
C.G.S. §§ 51-346, 51-347, $1-349, 51-350, 52-45a, SUPERIOR COURT
52-48, 52-259, P.B. §§ 3-1 through 3-27, 8-1, 10-13, jud.ct.gov
See other side for instructions
gd “X"" if amount, legal interest or property in demand, not including interest and
costs is less than $2,500.
gO ™X"" if amount, legal interest or property in demand, not including interest and
costs is $2,500 or more.
i ""X"" if claiming other relief in addition to or in lieu of money or damages.
TO: Any proper officer; BY AUTHORITY OF THE STATE OF CONNECTICUT, you are hereby commanded to make due and legal service of
this Summons and attached Complaint.
Address of court clerk where writ and other papers shall be filed (Number, street, town and zip code) | Telephone number of clerk Return Date (Must be a Tuesday)
(C.G.8, §§ 54-346, 61-350) ‘with-erea.code). em 016
15 West Street, Litchfield, CT 06759 860-567-0885 [Moa Day Year
i - At (Town fn which writ is returnable) (C.G,S. §§ 57-346, 51-349) Case type code (See lisf on page 2)
f] Judiciai District .
Oo oA Litchfield
Number:
1 Housing Session Major: P Minor: 00
For the Plaintiff(s) please enter the appearance of:
Name and address of atfomey, law firm or piainiiff i self-represented (Number, street, town and zip code) ‘Juris number (to bs entared by atiornoy only)
McCalla Raymer Leibert Pierce, L1.C, 50 Weston Street, Hartford, CT 08120 101589
Telephone number (with area code) ‘Signature of Plaintif (if seltrepresented)
(860) 808-0606
‘The attorney or law firm appearing for the plaintiff, or the plaintiff if a o Email address tor celivery of papers under Section 10-13 (if agreed to}
seif-represented, agrees io accept papers (service) electronically in Yes No
this case under Section 10-13 of the Connecticut Practice Book. ctcourtnotices@mecalla.com
Number of Plaintiffs: 1 Number of Defendants: 5 fa Form JD-CV-2 attached for additional parties :
Parties Name (Last, First, Middle initial) and Address of Each party (Number; Street; P.O. Box; Town; State; Zip; Country, if not USA)
DEUTSCHE BANK NATIONAL TRUST COMPANY, as trustee for SECURITIZED ASSET BACKED RECEIVABLES. P01
pers ff Name: LLC TRUST 2007-BR4, MORTGAGE PASS-THROUGH CERTIFICATES, SERIES 2007-BR4
" 1661 Worthington Road, West Palm Beach, FL 33416
Additional Name: P-02
Plaintiff Address:
First Name: Polley, Amy S. a/k/a Amy Polley also known as Amy S, Machuga D-01
Defendant Address: 146 High St, Torrington, CT 06790-5108
State of Connecticut Department of Revenue Services D-02
C/O Attorney General, George C. Jepsen, 55 Elm Street, Hartford, CT 06406, Address: 450 Columbus Boulevard,
Suite 1, Hartford, CT 06103.
Additional Name:
Defendant Address:
Additional Name: The Charlotte Hungerford Hospital D038
Defendant | Address; C/O its Agent: Daniel J. Mcintyre, The Charlotte Hungerford Hospital, 540 Litchfield Street, Torrington, CT 06790
Additional Name; The Waterbury Hospital D-04
Defendant | Address: C/O Secretary, 64 Robbins Street, Waterbury, CT 06708
Notice to Each Defendant
1. YOU ARE BEING SUED. This paper is a Summons in a lawsuit. The complaint attached to these papers states the claims that each plaintiff is making
against you in this lawsuit.
2. To be notified of further proceedings, you or your attorney must file a form called an ““Appearance" with the clerk of the above-named Court at the above
Court address on or before the second day after the above Return Date. The Return Date is not a hearing date, You do not have to come to court on the
Return Date unless you receive a separate notice telling you to come to court.
3. Ifyou or your attorney do not file a written ""Appearance™ form on time, a judgment may be entered against you by default. The "Appearance form may
be obtained at the Court address above or at www,jud.ct.gov under “Court Forms."
4, Ifyou believe that you have insurance that may cover the claim that is being made against you in this jawsuit, you should immediately contact your
insurance representative, Other action you may have to take is described in the Connecticut Practice Book which may be found in a superior court law
library or on-line at www.jud,cl.gov under "Court Rules."
5, If you have questions about the Supamons and Complaint, you should talk to an attorney quickly. The Clerk of Court is not allowed to give advice on
legat questions. 2
Signed (Sign and "x proper ye Gapimissioner of the jame of Porson Signipg at left Date signed
Sieerior Court ivsha Becks
i an Clerk ord to jon } 2017
If this Summons is signed by a Cie: For Court Use Only
a. The signing has been done so thal the Plaintiff(Sy Wil not Be denied access to the courts. Fie Dale
b. Itis the responsibility of the Plaintif(s) to see that service is made in the manner provided by law.
c. The Clerk is not permitted to give anY legal advice in connection with any lawsuit.
d. The Clerk signing this Summons at the request of the Plaintiff(s) is not responsible in any way for any errors or omissions
in the Summons, any allegations contained in the Complaint, or the service of the Summons or Complaint.
I certify | have read and Signed (Self Represented Plaintiff Date Docket Number
understand the above: LLI-CV16-6014318-S
(Page 1 oF 2)CIVIL SUMMONS
TTINUATION OF PARTIE: STATE OF CONNECTICUT
Sone Rev. 9-42 $ SUPERIOR COURT
First named Plaintiff (Last, First, Midalle Initial)
DEUTSCHE BANK NATIONAL TRUST COMPANY, as trustee for SECURITIZED ASSET BACKED RECEIVABLES LLC TRUST 2007-BR4,
MORTGAGE PASS-THROUGH CERTIFICATES, SERIES 2007-BR4
First named Defendant (Last, First, Middle tnitial)
Amy S, Polley a/k/a Amy Polley also known as Amy S, Machuga
Additional Plaintiffs
Name (Last, First, Middle initial, if individual)
Address (Number, Street, Town and Zip Code)
coe
03,
04.
05
O06
O7
08
og
12
13
Additional Defendants
Name (Last, First, Middle Inttiai, if individual)
Address (Number, Street, Town and Zip Code}
Cope
Maletta Pfeiffer and Associates, LLC alk/a Physical Therapy Genter
cio Agent: Gregory J. Spuches , 20 Field Drive , Wethersfield , CT 06109;
Address; 30 Peck Road, Torrington, CT 08790
05
06
07
08
os
10
{1
12
FOR COURT USE ONLY - File Date
Docket Number
CIVIL SUMMONS-ContinuationInstructions
1. Type or print legibly; sign summons.
2. Prepare or photocopy a summons for each defendant.
3. Attach the original summons to the original complaint, and attach a copy of the summons to each copy of the complaint. Also, if there are
more than 2 plaintiffs or more than 4 defendants prepare form JD-CV-2 and attach it fo the original and all copies of the complaint,
4, After service has been made by a proper officer, file original papers and officer's retum with the clerk of court.
5. Do not use this form for the following actions:
(a) Family matters (for example divorce, child support, () Proceedings pertaining to arbitration
custody, patemity, and visitation matters) (g) Any actions or proceedings in which an attachment,
(b) Surnmary Process actions gamishment or replevy is sought
(c) Applications for change of name (h) Entry and Detainer proceedings
(d) Probate appeals (i) Housing Code Enforcement actions
(e) Administrative appeals
ADA NOTICE
The Judicial Branch of the State of Connecticut complies with the Americans with
Disabilities Act (ADA). If you need a reasonable accommodation in accordance with
the ADA, contact a court clerk or an ADA contact person listed at www, jud.ct.gov/ADA.
Case Type Codes
: , Codes , : Codes
Major Description | Major! Minor Description Major Description| Major/ Minor Description
Minor Minor
Contracts C00 | Construction - Ail other Property P00 | Foreciosure
C10 | Construction - State and Local P10. | Partition i
20 | Insurance Policy P20 | Quiet Title/Discharge of Mortgage or Lien
30 | Specific Performance P30 | Asset Forfelture
40 | Coltections P90 | Allother
ceo | Allother
Torts (Other than} 02 | Defective Premises - Private - Snow or Ice
Eminent Domain | £00 | State Highway Condemnation Vehicular) T03__ | Defective Premises - Private - Other
E10 | Redevelopment Condemnation T14 —| Defective Premises - Public - Snow or Ice
E20 | Other State or Municipal Agencies 112 | Defective Premises - Public - Other
£30 | Public Utilities & Gas Transmission Companies T20 | Products Liability - Other than Vehicular
E90 J Allother 128 | Malpractice - Medical
129 | Malpractice - Legal
730 | Malpractice - Ail othes
3 tow T 4a | Assault and Battery
ma jencames 50 | Defamation
M30. | Habeas Corpus (extradition, release from Penal
Insttution) Te1 | Animals - Dog
89° | Animals - Other
170 | False Arest
Miscellaneous M00 | Injunction
M10 Receivership.
Ma | Arbitration
M50 | Declaratory Judgment
Mes | Bar Discipline 774 | Fire Damage
M66__| Department of Labor Unemployment Compensation T90 | Allother
Enforcement _
Mes | Bar Discipline - Inactive Status Vehicular Torts 01 | Motor Vehicles” - Driver and/or Passenger(s) vs. :
Driver(s) !
M70 | Municipal Ordinance and Regulation Enforcement ;
04 | Motor Vehicles* - Pedestrian vs. Driver
M80 | Foreign Civil Judgments - C.G.S. 52-604 & C.G.5.
50a-30 V08 | Motor Vehicles* - Properly Damage oniy
Mea | Small Claims Transfer to Regular Docket V08 j Motor Vehicle* - Products Liability Including Warranty
Mad _| Foreign Protective Order V09 | Motor Vehicte* - All other
M30. | Alfother V10 | Boats
V20 | Airplanes
Housing 110 | Housing - Return of Security Deposit V30 | Railroads
H12 | Housing - Rent and/or Damages veo | snowmobiles
H40 | Housing - Audila Querela/Injunction voo | Allother
H60_ | Housing - Administrative Appeal *Motor Vehicles include cars, trucks, motorcycles,
H60 | Housing - Municipal Enforcement and motor scooters.
0 | Housing - All Other
Wills, Estates W419 | Construction of Wills and Trusts
and Trusts wso | Allother
JD-CV-4 Rev. 4-16 (Back/Page 2)