FILED: FULTON COUNTY CLERK 04/22/2021 12:24 PM
`NYSCEF DOC. NO. 5
`
`INDEX NO. EF2020-08421
`
`RECEIVED NYSCEF: 03/29/2022
`
`REQUEST
`
`SUPREME
`
`INTERVENTION
`FOR JUDICIAL
`3 COURT, COUNTY OF FULTON
`
`Index N
`
`08421
`
`Date index
`
`Issued:
`
`07/31/2020
`
`ANTHONYN.CHAMBERS,
`
`-against-
`BROADALBIN-PERTH
`SCHOOL
`CENTRAL
`
`CENTRAL
`DISTRICT
`
`SCHOOL
`DISTRIC
`BOARD
`OF EDUCATION,
`
`AND BROADALBIN-PERTH
`
`..
`
`Plaintiff(s)/Petitioner(s)
`
`Assi
`
`Defendant(s)/Respondent(s)
`
`ΠBusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.)
`O Contract
`O insurance (where insurance company is a party, except arbitration)
`O ucc (includes sales and negotiable instruments)
`O Other Commeretat (specify):
`to 22 NYCRR202.70(d),
`NOTE:For Commerciot Division assignment requests pursuant
`complete ond attach the COMMERCIALDMSION RJiADDENDUM (UCS-840C).
`eli
`11Èathedncludes
`piTifit
`spenits,the'sp
`
`O Residential
`
`O commercial
`
`O condemnation
`O Mortgage rareciosure (specify):
`Property Address:
`NOTE: For Mortgage Foreclosure octions involving a one to four-family,
`owner-occupied residentiot property or owner-occupied condominium,
`complete ond ottach the FORECLOSURERJiADDENDUM (UCS-840FL
`O Tax Certiorari
`O Tax Foreclosure
`O Other Real Property (specify):
`
`.
`
`3
`
`ú
`[see NOTE in COMMERCIALsection}
`
`O certmcate of incorporation/Dissolution
`O Emergency MedicalÄreatment
`O HabeasCorpus
`O Local Court Appeat
`O Mechanic's Lien
`O Name Change
`O Pistol Permit Revocation Hearing
`Saleor Finance of Religious/Not-for-Profit Property
`O Other (specify):
`
`(cid:16)-- C
`m
`
`.
`
`-
`
`F1
`
`O Contested
`NOTE: If there are children under the age of18, complete ond attach the
`MATRIMONIAL RMADDENDUM (UCS-840M).
`For Uncontested Matrimonial octions, use the Uncontested Divorce RJi(UD-13[
`Tourts
`.
`O Asbestos
`@ Child Victims Act
`O environmental
`(specify):
`O Medical, Dental or Podiatric Malpractice
`O Motor vehicle
`O Products Liability (specify):
`O Other Negligence (specify):
`O Other Professional Malpractice (specify)
`O Other Tort (specify):
`.e
`O CPLRArticle 75 (Arbitration)
`[see NOTE in COMMERCIALsection]
`O CPLRArticle 78 (Body or Officer)
`O Election Law
`O Extreme Risk Protection Order
`Q MHL Article 9.60 (Kendra's Law)
`O MHL Article 10 (Sex Offender Confinement-Initial)
`O MHL Article 10 (5ex Offender Confinement-Review}
`O MHL Article 81 (Guardianship)
`O Other Mental Hygiene (specify):
`O Other Special Proceeding (specify):
`
`.
`
`I
`
`Hasa summons and complaint or summons with notice been filed?
`Hasa summons and complaint or summons with notice been served?
`is this action/proceeding being filed post-judgment?
`
`YE5
`8
`6
`O
`
`NO
`O
`If yes, date filed:
`O
`if yes, date served:
`@ If yes, judgment date:
`
`07/31/2020
`07/31/2020
`
`O infant's Compromise
`O Extreme RiskProtection Order Application
`O Note of Issue/Certificate of Readiness
`O Notice of Medical, Dental or Podiathe Malpractice
`O Notice of Motion
`O Notice of Petition
`O Order to Show Cause
`O Other ExParte Application
`O Poor Person Application
`O Request for Preliminary Conference
`O Residential Mortgage Foreclosure Settlement Conference
`O writ of Habeascorpus
`O other(specify):
`
`Date IssueJoined: _
`Rellef Requested:
`Relief Requested:
`Relief Requested:
`Relief Requested:
`
`1 of 2
`
`Return Date:
`Return Date:
`Return Date:
`
`

`

`FILED: FULTON COUNTY CLERK 04/22/2021 12:24 PM
`NYSCEF DOC. NO. 5
`
`INDEX NO. EF2020-08421
`
`RECEIVED NYSCEF: 03/29/2022
`
`O Name:AnthonyN.Chambers
`Role(sh
`Plaintiff
`Name: Broadalwr erthCentralSchadDistrict Gregory S. Mills, Esq., The Mills Law Firm, LLP, 1520 Crescent Road, Ste.
`Role(s):
`100, Clifton Park, NY 12065, P: 518-373-9900,
`gmHis@minslawny.com
`Defendant
`mrmC
`
`Name:
`Role(s):
`
`kWBe E
`
`Defendant
`
`.
`e
`
`Jason A. Frament, Esq., LaFave Wein & Frament PLLC, 2400 Western
`Avenue, Guilderland, NY 12084 P: 518-869-9094, www.LWFLegatcom
`
`_Mills, Esq., The Mills Law Firm, LLP, 1520 Crescent Road, Ste.
`100, Clifton Park, NY 12065, P: 518-373-9900,
`gmillslawny.com
`
`O YES O NO
`
`O YES O NO
`
`se|f-insured
`
`@ YES O NO
`
`Self-in$ured
`
`O YES O NO
`
`O YES O NO
`
`O YEs O NO
`
`O YES O NO
`
`O YES O NO
`
`O YES O NO
`
`O YES O NO
`
`I
`
`O YES O NO
`
`O YES O NO
`
`O YES O NO
`
`Q YES O NO
`
`Q YES Q NO
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`noie(s):
`
`Name:
`Rote(s):
`
`Name:
`Role(s):
`
`Name:
`Role(sJ:
`
`Name:
`Role(s):
`
`Name:
`Role(s);
`
`Name:
`Role(s):
`
`I AFFIRM UNDER THE PENALTY OF PER-URY THAT, UPON INFORMATION
`AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS,
`EXCEPT AS NOTED ABOVE, NOR H/S A REQUEST FOR JUDICIAL INTERVENTION
`BEEN PREVIOUSLY FILED \N THIS ACTION OR PROCEEDING.
`
`Dated:
`
`4
`
`4
`
`1489459
`Registration
`
`Number
`
`Attorney
`
`Signature
`
`S. Mills
`Gregory
`Print Name
`
`2 of 2
`
`