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`CAPTION
`REQUEST FOR JUDICIAL INTERVENTION
`SUPREME COURT, COUNTY OF NASSAU
`Index No: 615440/2025 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.
`UCS-840
`(rev. 12/16/2024)
`For Court Use Only:
`IAS Entry Date
`Theresa Marie Nicoletto
`Plaintiff(s)/Petitioners) Judge Assigned
`-against-
`Town of Huntington Town Clerk's office and
`Town of OusteBay Town Clerks ofte
`RJI Filed Date
`Defendants)/Respondent(s)
`NATURE OF ACTION OR PROCEEDING Check only one box and specify where indicated.
`COMMERICIAL
`Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.)
`Contract
`Insurance (where insurance company is a party, except arbitration)
`? UCC (includes sales and negotiable instruments)
`Other Commercial (specify):
`NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
`complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C).
`TORTS
`? Asbestos
`? Environmental (specify):
`? Medical, Dental or Podiatric Malpractice
`? Motor Vehicle
`? Products Liability (specify):
`? Other Negligence (specify):
`? Other Professional Malpractice (specify):
`? Other Tort (specify):
`SPECIAL PROCEEDINGS
`? Child-Parent Security Act (specify): Assisted Reproduction Surrogacy Agreement
`? CPLR Article 75 - Arbitration [see NOTE in COMMERCIAL section)
`? CPLR Article 78 - Proceeding against a Body or Officer
`? Election Law
`? Extreme Risk Protection Order
`? MHL Article 9.60 - Kendra's Law
`? MHL Article 10 - Sex Offender Confinement (specify): Initial ?Review
`? MHL Article 81 (Guardianship)
`? Other Mental Hygiene (specify):
`Other Special Proceeding (specify):
`STATUS OF ACTION OR PROCEEDING
`MATRIMONIAL
`? Contested
`NOTE: If there are children under the age of 18, complete and attach the
`MATRIMONIAL RJI ADDENDUM (UCS-840M).
`For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
`REAL PROPERTY Specify how many properties the application includes:
`Condemnation
`Mortgage Foreclosure (specify): Residential Commercial
`Property Address:
`NOTE: For Mortgage Foreclosure actions involving a one to four-family,
`owner-occupied residential property or owner-occupied condominium,
`complete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F).
`? Partition
`NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P).
`? Tax Certiorari (specify): Section: - Block: Lot:
`? Tax Foreclosure
`Other Real Property (specify):
`OTHER MATTERS
`Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section]
`Emergency Medical Treatment
`Habeas Corpus
`Local Court Appeal
`Mechanic's Lien
`? Name Change/Sex Designation Change
`Pistol Permit Revocation Hearing
`Sale or Finance of Religious/ Not-for-Profit Property
`Other (specify):
`Has a summons and complaint or summons with notice been filed?
`Has a summons and complaint or summons with notice been served?
`Is this action/proceeding being filed post-judgment?
`NATURE OF JUDICIAL INTERVENTION
`Infant's Compromise
`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
`Partition Settlement Conference
`Request for Preliminary Conference
`Residential Mortgage Foreclosure Settlement Conference
`Waiver of Court Costs, Fees, and Expenses
`Writ of Habeas Corpus
`Other (specify):
`Answer YES or NO for every question and enter additional information where indicated.
`YES NO
`If yes, date filed:
`If yes, date served:
`If yes, judgment date:
`Check one box only and enter additional information where indicated.
`10/22/2025
`1|28/2025
`08 2025°
`t1sa poolin
`aprwork ul perno tiòn .
`Date Issue Joined: _Relief Requested: James Nicelet is birth cofficateReturn Date: 12/22 2625
`Relief Requested: May Nicoto's dent crhf Return Date:
`Relief Requested: ONS for James Nicolett, Return Date:
`Relief Requested:
`Vincenzo Nicolette and Maria Saveria Amendolara
`FILED: NASSAU COUNTY CLERK 12/10/2025 01:43 PMINDEX NO. 615440/2025
`NYSCEF DOC. NO. 39 RECEIVED NYSCEF: 12/10/2025
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`RELATED CASES
`Case Title
`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) Relationship to instant case
`PARTIES
`Un-
`Rep
`For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space provided.
`If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
`Parties Attorneys and Unrepresented Litigants
`List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone and
`caption and indicate roles (e.g, plaintiff, email. For unrepresented parties, provide party's address, phone and email.
`defendant, 3"* party plaintiff, etc.)
`For each defendant,
`indicate if issue has
`been joined.
`Insurance Carriers
`For each defendant,
`indicate insurance
`carrier, if applicable.
`Name: Niolette, Therera Men theresa Nicoleto, 80i Ne roSte Aptsor
`Plus toff / Petitione oklahoma City, 0K 73106+nicolettagmail. con © NO
`han Chi Sting ten To -35 8012 to tun the a 1572324 go
`Defendent / Respondent
`© NO
`Name: Town of OystV Bau
`54 Audrey OYES
`516-624 - 6150, clamaradoystrbag-ny. gov
`? NO
`O YES O NORole(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):
`O YES
`O YES
`OYES
`O YES
`O YES
`OYES
`OYES
`O YES
`OYES
`O YES
`OYES
`O NO
`O NO
`O NO
`O NO
`ONO
`O NO
`O NO
`O NO
`ONO
`O NO
`O 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.
`Dated: 11/19/2025
`Attorney Registration Number
`Signature
`thereon Mrie Nicoll
`Print Name
`FILED: NASSAU COUNTY CLERK 12/10/2025 01:43 PMINDEX NO. 615440/2025
`NYSCEF DOC. NO. 39 RECEIVED NYSCEF: 12/10/2025
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