Preview
FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF CORTLAND
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK,
Plaintiff, :
-against- :
WILLIAM SCOTT HICKS DBA CORTLAND FLOORCRAFT :
AFFIRMATION
Defendant(s) :
OF
NON-PAYMENT
:
X
Workers'
The undersigned, an attorney in theoffice of the Compensation Board of the State of New
York, Plaintiffherein, hereby affirmsthat the following is trueunder the penalty of perjury,upon
information and belief:
W'uikeis'
This affirmationisbased upon a review of the file
which ismaintained by the Compensation
Board inits regularcourse of business.
I am familiarwith the status of payment in thismatter. The award/penalty/assessment/demand for
depositof security made against the defendant(s) in theamount of $8,500.00 is as
in default, more than
days
thirty have elapsed since the demand upon the defendant(s) herein for payment. No payment has
been received nor has the aforesaid securitybeen deposited incGiiip|iânce with said demand todate,
except the sum of $19.98, leavingdue and payble the sum of $8,480.02.
Dated: 18th day of January , 2022 .
S/
James R. McGinn, Esq.
Judgment Unit
' 2022313312
EF22-068
02/17/2022 12:49:07PM
Pages 7
WORKERS COMPENSATION APPLICATK
C-45.45E 1/2009 Elizabeth Larkin, County Clerk
1 of 5
FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF CORTLAND
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK,
Plaintiff, :
-against- :
WILLIAM SCOTT HICKS DBA CORTLAND FLOORCRAFT :
AFFIRMATION
Defendant(s) :
OF
REGULARITY
X
WGrkers'
The undersigiled, an attorney in theoffice of the Compensation Board of the Stateof New
York, Plaintiffherein, hereby affirms that the followingis trueunder the penalty of perjury,upon
information and belief:
Workers'
This aiririñät|oil
isbased 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 inthe sum of $8,500.00, against the
defendant(s). Attached hereto and made a part hereof are certifiedcopies of the Notice of Decision and
Award, and/or a certifiedcopy ofthe demand for deposit of security,and/or a Gertifiedcopy 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 $19.98, leaving $8,480.02 due and payable.
WHEREFORE, it isrespectfu!Iyrequested that judgment be entered against the Defendant(s) herein in
the sum stated as remaining due and payable.
Dated: 18th day of January__, 2022 .
S/
James R. McGinn, Esq.
Judgment Unit
C-45.1E 6/2007
2 of 5
FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022
STATE OF NEW YORK
WORKERS'
NEW Workers' COMPENSATION BOARD THISAGENCYEMPLOYSAND SERVES
JUDGMENT UNIT PEOPLEWTH DISABILITES WTHOUT
ÏŸZE Compensat1ort
328 STATE STREET DISCRIMINATION.
Board
SCHENECTADY, NY 12305-2318
866-298-7830
WILLIAM SCOTT HICKS WCB EMPLOYER #: 1259904
DBA CORTLAND FLOORCRAFT UlER #: 55-24410
4357 N HOMER AVE EXT
FEIN/SS # *****0333
CORTLAND NY 13045-1092
It is
hereby certified
that thisis a true
and correct copy ofthe originalas filed
Workers'
with the Compensation Board
S/
* 1"" s R cGnn, Es4
FINAL NOTICE -r·. Unit
DATE: 01/17/2022
cor+md - ampm
Non-Compliance
Item Description Dates Accident Date Bê!añœ Due
I
2019W0019013 Failure to Workers' Ins 03/07/2019-08/27/2019 $8, 480. 02
Carry Comp
Total Balance Due $8,480.02
*
Ifpayment isnot received immêdiately, judgmêñt willbe filedand the employer is subjectto seizure
of assets, both business and personal, without further noticefrom the Board.
In orderto insureprompt creditof yourpåyment, emp!ete thefc!!cwD:gwiththe
Date, Nurnber and Amount of yourcheck and return with
it, along your payment to:
WORKERS'
COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET, SCHENECTADY, NY 12305-2318
Please detach and retum bottom portion with your payment.
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
iiiPÏûÏ6i WILL[AM SCOTT HICKS DBA CORTLAND FLOORCRAFT WCB Employer # 1259904
Customer ID # 1160205
Check
Check Date Check #
Amount
C-45.37 5/2004 Page 1 Of 2
3 of 5
FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022
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
4 of 5
FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF CORTLAND
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK, JUDGMENT
Plaintiff, :
-against- : EMP# : 1259904
: JUD# : 2173343
WILLIAM SCOTT HICKS DBA CORTLAND FLOORCRAFT :
Defendant(s) : INDEX # :
FILING DT:
X
Workers'
By order of the Chair of the Compensaticñ Board of the Stateof New York, demand forthe
payment of the sum of $8,500.00, representing Awards and Penalties having been made against the
above captioned Defendant(s), afterdue notice,having defau!ted in payment thereof,except the sum of
$19.98 leaving $8,480.02 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 of judgreent by the
Workers'
County Clerk in event of such default, itis 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; 4357 N HOMER AVE EXT,
CORTLAND, NY 13045-1092, respectively; the sum of $8,480.02, 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
5 of 5
Preview
FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF CORTLAND X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, Plaintiff, : -against- : WILLIAM SCOTT HICKS DBA CORTLAND FLOORCRAFT : AFFIRMATION Defendant(s) : OF NON-PAYMENT : X Workers' The undersigned, an attorney in theoffice of the Compensation Board of the State of New York, Plaintiffherein, hereby affirmsthat the following is trueunder the penalty of perjury,upon information and belief: W'uikeis' This affirmationisbased upon a review of the file which ismaintained by the Compensation Board inits regularcourse of business. I am familiarwith the status of payment in thismatter. The award/penalty/assessment/demand for depositof security made against the defendant(s) in theamount of $8,500.00 is as in default, more than days thirty have elapsed since the demand upon the defendant(s) herein for payment. No payment has been received nor has the aforesaid securitybeen deposited incGiiip|iânce with said demand todate, except the sum of $19.98, leavingdue and payble the sum of $8,480.02. Dated: 18th day of January , 2022 . S/ James R. McGinn, Esq. Judgment Unit ' 2022313312 EF22-068 02/17/2022 12:49:07PM Pages 7 WORKERS COMPENSATION APPLICATK C-45.45E 1/2009 Elizabeth Larkin, County Clerk 1 of 5 FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF CORTLAND X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, Plaintiff, : -against- : WILLIAM SCOTT HICKS DBA CORTLAND FLOORCRAFT : AFFIRMATION Defendant(s) : OF REGULARITY X WGrkers' The undersigiled, an attorney in theoffice of the Compensation Board of the Stateof New York, Plaintiffherein, hereby affirms that the followingis trueunder the penalty of perjury,upon information and belief: Workers' This aiririñät|oil isbased 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 inthe sum of $8,500.00, against the defendant(s). Attached hereto and made a part hereof are certifiedcopies of the Notice of Decision and Award, and/or a certifiedcopy ofthe demand for deposit of security,and/or a Gertifiedcopy 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 $19.98, leaving $8,480.02 due and payable. WHEREFORE, it isrespectfu!Iyrequested that judgment be entered against the Defendant(s) herein in the sum stated as remaining due and payable. Dated: 18th day of January__, 2022 . S/ James R. McGinn, Esq. Judgment Unit C-45.1E 6/2007 2 of 5 FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022 STATE OF NEW YORK WORKERS' NEW Workers' COMPENSATION BOARD THISAGENCYEMPLOYSAND SERVES JUDGMENT UNIT PEOPLEWTH DISABILITES WTHOUT ÏŸZE Compensat1ort 328 STATE STREET DISCRIMINATION. Board SCHENECTADY, NY 12305-2318 866-298-7830 WILLIAM SCOTT HICKS WCB EMPLOYER #: 1259904 DBA CORTLAND FLOORCRAFT UlER #: 55-24410 4357 N HOMER AVE EXT FEIN/SS # *****0333 CORTLAND NY 13045-1092 It is hereby certified that thisis a true and correct copy ofthe originalas filed Workers' with the Compensation Board S/ * 1"" s R cGnn, Es4 FINAL NOTICE -r·. Unit DATE: 01/17/2022 cor+md - ampm Non-Compliance Item Description Dates Accident Date Bê!añœ Due I 2019W0019013 Failure to Workers' Ins 03/07/2019-08/27/2019 $8, 480. 02 Carry Comp Total Balance Due $8,480.02 * Ifpayment isnot received immêdiately, judgmêñt willbe filedand the employer is subjectto seizure of assets, both business and personal, without further noticefrom the Board. In orderto insureprompt creditof yourpåyment, emp!ete thefc!!cwD:gwiththe Date, Nurnber and Amount of yourcheck and return with it, along your payment to: WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET, SCHENECTADY, NY 12305-2318 Please detach and retum bottom portion with your payment. MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. iiiPÏûÏ6i WILL[AM SCOTT HICKS DBA CORTLAND FLOORCRAFT WCB Employer # 1259904 Customer ID # 1160205 Check Check Date Check # Amount C-45.37 5/2004 Page 1 Of 2 3 of 5 FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022 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 4 of 5 FILED: CORTLAND COUNTY CLERK 02/17/2022 12:49 PM INDEX NO. EF22-068 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 02/17/2022 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF CORTLAND X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, JUDGMENT Plaintiff, : -against- : EMP# : 1259904 : JUD# : 2173343 WILLIAM SCOTT HICKS DBA CORTLAND FLOORCRAFT : Defendant(s) : INDEX # : FILING DT: X Workers' By order of the Chair of the Compensaticñ Board of the Stateof New York, demand forthe payment of the sum of $8,500.00, representing Awards and Penalties having been made against the above captioned Defendant(s), afterdue notice,having defau!ted in payment thereof,except the sum of $19.98 leaving $8,480.02 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 of judgreent by the Workers' County Clerk in event of such default, itis 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; 4357 N HOMER AVE EXT, CORTLAND, NY 13045-1092, respectively; the sum of $8,480.02, 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 5 of 5