FILED: MONTGOMERY COUNTY CLERK 09/17/2021 05:04 PM
`NYSCEF DOC. NO. 17
`
`INDEX NO. EF2021-3
`
`RECEIVED NYSCEF: 09/17/2021
`UCS-840
`(rev. 07/29/2019)
`
`REQUEST FOR JUDICIAL INTERVENTION
`SUPREME
`MONTGOMERY
`_______________ COURT, COUNTY OF _______________
`EF2021-3
`01/04/2021
`Index No: _______________
`Date Index Issued: _______________
`Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet.
`
`CAPTION
`JPMORGAN CHASE BANK, N.A.
`
`For Court Use Only:
`IAS Entry Date
`
`
`
`-against-
`MS DIANE L COMPANI
`
`Plaintiff(s)/Petitioner(s)
`
`Judge Assigned
`
`
`
`RJI Filed Date
`
`
`
`Defendant(s)/Respondent(s)
`
`[see NOTE in COMMERCIAL section]
`
`Check only one box and specify where indicated.
`NATURE OF ACTION OR PROCEEDING
`MATRIMONIAL
`COMMERICIAL
` Contested
` Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.)
`NOTE: If there are children under the age of 18, complete and attach the
` Contract
`MATRIMONIAL RJI ADDENDUM (UCS-840M).
`
`Insurance (where insurance company is a party, except arbitration)
`For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
` UCC (includes sales and negotiable instruments)
` Other Commercial (specify): _____________________________________________ TORTS
`NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
` Asbestos
`complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C).
` Child Victims Act
`REAL PROPERTY
`Specify how many properties the application includes: _______
` Environmental (specify): _______________________________________________
` Condemnation
` Medical, Dental or Podiatric Malpractice
` Commercial
` Residential
` Mortgage Foreclosure (specify):
` Motor Vehicle
`Property Address: ____________________________________________________
` Products Liability (specify): ____________________________________________
`NOTE: For Mortgage Foreclosure actions involving a one to four-family,
` Other Negligence (specify): ____________________________________________
`owner-occupied residential property or owner-occupied condominium,
` Other Professional Malpractice (specify): _________________________________
`complete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F).
` Other Tort (specify): __________________________________________________
`SPECIAL PROCEEDINGS
` Tax Certiorari
` Tax Foreclosure
` CPLR Article 75 (Arbitration) [see NOTE in COMMERCIAL section]
` Other Real Property (specify): ___________________________________________
` CPLR Article 78 (Body or Officer)
`OTHER MATTERS
` Election Law
` Certificate of Incorporation/Dissolution
` Extreme Risk Protection Order
`
` Emergency Medical Treatment
`
` Habeas Corpus
` MHL Article 10 (Sex Offender Confinement-Initial)
`
`Local Court Appeal
` MHL Article 10 (Sex Offender Confinement-Review)
`
`
` MHL Article 81 (Guardianship)
` Name Change
` Other Mental Hygiene (specify): ________________________________________
` Pistol Permit Revocation Hearing
` Other Special Proceeding (specify): ______________________________________
`
` Sale or Finance of Religious/Not-for-Profit Property
`CIVIL CONTRACT
`
` Other (specify): ______________________________________________________
`STATUS OF ACTION OR PROCEEDING
`Answer YES or NO for every question and enter additional information where indicated.
`YES
`NO
`
`01/04/2021
`___________________
`If yes, date filed:
`Has a summons and complaint or summons with notice been filed?
`
`
`02/10/2021
`___________________
`If yes, date served:
`Has a summons and complaint or summons with notice been served?
`
`
`
`Is this action/proceeding being filed post-judgment?
`
`If yes, judgment date: ___________________
`NATURE OF JUDICIAL INTERVENTION
`Check one box only and enter additional information where indicated.
`
`
` Extreme Risk Protection Order Application
` Note of Issue/Certificate of Readiness
` Notice of Medical, Dental or Podiatric Malpractice
` Notice of Motion
` Notice of Petition
` Order to Show Cause
` Other Ex Parte Application
` Poor Person Application
` Request for Preliminary Conference
` Residential Mortgage Foreclosure Settlement Conference
` Writ of Habeas Corpus
` Other (specify): ____________________________________________________________________________
`1 of 2
`
`Date Issue Joined: ___________________
`SUMMARY JUDGMENT
`Relief Requested: ______________________________
`Relief Requested: ______________________________
`Relief Requested: ______________________________
`Relief Requested: ______________________________
`
`Return Date: ___________________
`Return Date: ___________________
`Return Date: ___________________
`
`
`

`

`FILED: MONTGOMERY COUNTY CLERK 09/17/2021 05:04 PM
`NYSCEF DOC. NO. 17
`RECEIVED NYSCEF: 09/17/2021
`RELATED CASES
`List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank.
`If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
`Index/Case Number
`Court
`Judge (if assigned)
`
`Case Title
`
`Relationship to instant case
`
`INDEX NO. EF2021-3
`
`-
`If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
`Attorneys and Unrepresented Litigants
`For represented parties, provide attorney name, firm name, address, phone and
`email. For unrepresented parties, provide
`address, phone and email.
`
`, phone number and email in the space provided.
`
`PARTIES
`
`Un-
`Rep
`
`Parties
`List parties in same order as listed in the
`caption and indicate roles (e.g., plaintiff,
`defendant, 3rd party plaintiff, etc.)
`Name:
`JPMORGAN CHASE BANK, N.A.
`Role(s):
`Plaintiff
`MS DIANE L COMPANI
`Defendant
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`Name:
`Role(s):
`
`NATALIE DONALDSON, ESQ. 1787 VERTERANS MEMORIAL HWY, SUITE 32, ISLANDIA, NY 11749;
`631-234-1500; ndonaldson@rubinrothman.com
`
`STEVEN KOURAY ESQ, KOURAY & KOURAY, 525 STATE ST, SCHENECTADY, NY 12305;
`518-374-1200; STEVENK@KOURAY.COM
`
`Issue Joined
`For each defendant,
`indicate if issue has
`been joined.
`
`Insurance Carriers
`For each defendant,
`indicate insurance
`carrier, if applicable.
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
`
`YES
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`YES
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`YES
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`YES
`
`YES
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`NO
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`NO
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`NO
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`NO
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`NO
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`NO
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`NO
`
`NO
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`NO
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`NO
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`NO
`
`NO
`
`NO
`
`NO
`
`NO
`
`I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS,
`EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING.
`
`09/17/2021
`Dated: ___________________
`
`5096870
`________________________________________________________
`Attorney Registration Number
`
`_______________________________________________________
`Signature
`NATALIE DONALDSON, ESQ.
`_______________________________________________________
`Print Name
`
`2 of 2
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