`NYSCEF DOC. NO. 10
`
`INDEX NO. 2023-00023635
`
`RECEIVED NYSCEF: 12/15/2023
`
`SUPREME
`COUNTY
`
`COURT
`OF CLINTON
`
`Champlain
`
`EMS,
`
`Inc.
`
`Chad
`
`M. Ashline
`
`State
`
`County
`
`of New York
`of
`
`)
`) ss:
`
`STATE OF NEW YORK
`
`Plaintiff,
`
`Defendant.
`
`Index
`
`No.
`
`AFFIDAVIT
`FACTS
`
`OF
`
`Conh
`
`1NoMP.Co^·-1
`
`, being
`
`duly
`
`swom deposes
`
`and says:
`
`I am the
`personal
`have
`familiar
`with
`by Plaintiff
`
`(MTATAJ
`TErt 1
`of Champlain
`of
`the books
`of
`and records
`knowledge
`set
`and circumstances
`forth
`all of
`the facts
`this Affidavit.
`to make
`
`Inc.,
`
`the Plaintiff
`EMS,
`I am fully
`said Plaintiff,
`and
`and I am duly
`herein
`authorized
`
`herein.
`
`I
`
`Affidavit
`This
`constitution
`against
`
`the
`
`is submitted
`Plaintiff
`s claim
`Defendant(s).
`above
`
`pursuant
`herein
`
`to CPLR Section
`for
`purposes
`of
`
`the
`
`3215(f)
`entry
`
`as proof
`judgment
`
`of
`
`of
`
`the facts
`by default
`
`1.
`
`2.
`
`3.
`
`4.
`
`5.
`
`6.
`
`7.
`
`I have
`
`personal
`
`access
`
`of and
`knowledge
`electronic
`records,
`Records"),
`relating
`including
`the Account
`digits
`of
`four
`Defendants(s).
`last
`The
`procedures
`of Plaintiffs
`personal
`knowledge
`have
`Records
`Business
`Plaintiffs
`Businesa
`Records,
`of such
`the regular
`course
`business
`and
`it was
`at or near
`were make
`The Business
`Records
`of Plaintiff
`s Business
`Based
`on my review
`in this Affidavit.
`facts
`set
`forth
`
`books
`to Plaintiffs
`("Business
`records
`the above
`of
`to the account
`are §_10_4.
`number
`In my position,
`for
`and maintaining
`is
`creating
`were made
`in the regular
`course
`of
`to make
`the Business
`business
`Records.
`time
`therein.
`of
`the
`the
`events
`recorded
`I have
`personal
`knowledge
`of
`
`and
`
`I
`
`the
`
`records,
`
`statements
`
`set
`
`forth
`
`in Affidavit
`
`are true
`
`and
`
`correct
`
`to the best
`
`of my personal
`
`the
`All
`knowledge.
`
`The
`
`interest
`
`rate
`
`for
`
`consumer
`
`debt
`
`pursuant
`
`to CPLR Section
`
`5004
`
`applies
`
`to this
`
`action.
`
`Heretofore
`Defendant
`
`requested,
`
`and
`and/or
`
`desired,
`
`on or about
`Defendant's
`and/or
`
`December
`
`Plaintiff
`1, 2020,
`certain
`health
`dependent(s)
`by Defendant.
`required
`
`render
`and provide
`did
`to
`and medical
`care
`services
`
`as
`
`and
`of
`the fair,
`balance
`The
`reasonable,
`by Plaintiff
`rendered
`to Defendant
`services
`credit
`of all payments
`and
`other
`application
`payable
`outstanding.
`due
`and
`and
`
`price
`agreed
`and/or
`
`care
`
`and medical
`the health
`of
`Defendant's
`after
`dependent(s)
`all of which
`is $1,648.00,
`
`adjustments,
`
`is now
`
`1 of 2
`
`
`
`FILED: CLINTON COUNTY CLERK 12/15/2023 10:36 AM
`NYSCEF DOC. NO. 10
`
`INDEX NO. 2023-00023635
`
`RECEIVED NYSCEF: 12/15/2023
`
`8.
`
`9.
`
`10.
`
`11.
`
`The
`
`last
`
`recording
`assigned
`
`of
`
`the account
`digits
`four
`in the
`or
`a last
`payment,
`by Plaintiff
`to this
`
`indebtedness,
`
`number
`absence
`
`on the most
`printed
`statement
`of
`such
`6104
`are as follows:
`
`statement
`recent
`monthly
`the account
`number
`
`the amount
`date
`The
`of
`and
`on ; if no amount
`is inserted
`
`the last
`above
`
`made
`payment
`then Defendant
`
`by Defendant
`has made
`
`are $.00 which
`no payment
`on the
`
`was paid
`account.
`
`There
`currently
`the
`amount
`of
`October
`6, 2023
`interest
`accruing
`
`remains
`
`$1,648.00,
`at
`the
`thereon
`
`and owing
`due
`interest
`plus
`rate
`
`statutory
`thereafter
`
`by Defendant
`accrued
`thereon
`of 2% per
`annum
`the
`at
`rate
`
`statutory
`
`a principal
`to Plaintiff
`in
`balance
`from December
`through
`1, 2020
`in the
`amount
`of $93.82,
`plus
`of 2% per
`annum.
`
`Therefore
`accrued
`2% per
`
`statutory
`
`Plaintiff
`thereon
`annum
`rate
`
`in the
`of $1,648.00
`amount
`damaged
`has been
`principal,
`through
`from December
`1, 2020
`October
`at
`the
`6, 2023
`statutory
`in the amount
`of $93.82,
`interest
`plus
`thereon
`thereafter
`accruing
`of 2% per
`annum.
`
`plus
`
`interest
`rate
`at
`the
`
`of
`
`Sworn
`
`to before
`
`me this
`
`6 TH
`
`day
`
`of
`
`NOVIBMSER
`
`, 2023.
`
`Notary
`
`Public
`
`STEVEN
`PATNODE
`NOTARY PUBLIC-STATE
`OF NEW YORK
`No. 01PA4957262
`Qualified
`in Clinton
`My Commission
`Expires
`
`County
`10-16-2025
`
`2 of 2
`
`