FILED: ORLEANS COUNTY CLERK 09/14/2020
`NYSCEF DOC. NO. 3
`
`REQUEST
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`FOR JUDICIAL
`
`INTERVENTION
`
`SUPREME
`
`COURT, COUNTY OF NEW YORK
`
`INDEX NO. 20-46602
`
`RECEIVED NYSCEF: 02/09/2022
`D
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`ISC
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`o 5;*92019)
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`CAPTION
`
`Index No:
`Date Index lsSued:
`Enter the complete case caption. Do not use et al or et ano.
`If more space is needed, attach a caption rider sheet.
`
`07/09/2020
`
`20-46602
`
`For Court USe Only:
`
`IASEntry Date
`rm Co
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`AB 511 DOE
`
`-agamst
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`Lyndonville
`
`Lyndonville
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`Central
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`School
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`DiStrict
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`Elementary
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`School
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`Plaintiff(s)/Petitioner(s)
`
`JudgeAssigned
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`n
`
`coue
`
`a
`
`F
`
`Obt
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`Defendant(s)/Respondent(s)
`____
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`Check only one box and specify where indicated.
`MATRIMONIAL
`Q Contested
`NOTE:If there ore children under the age of 18, complete and attach the
`MATRIMONIAL RJIADDENDUM (UCS-840M).
`For Uncontested Matrimonial actions, use the Uncontested Divorce RJI(UD-13).
`TORTS
`Q Asbestos
`@ Child Victims Act
`Q Environmental (specify):
`O Medical, Dental or Podiatric Malpractice
`O Motor Vehicle
`Q Products Liability (specify):
`O Other Negligence (specify):
`O Other Professional Malpractice (specify):
`O Other Tort (specify):
`SPECIALPROCEEDINGS
`O CPLRArticle 75 (Arbitration) [see NOTEin COMMERCIALsection]
`Q CPLRArticle 78 (Body or Officer)
`O Election Law
`O Extreme RiskProtection Order
`O MHL Article 9.60 (Kendra's Law)
`Q MHL Article 10 (SexOffender Confinement-initial)
`O MHL Article 10 (SexOffender Confinement-Review)
`O MHL Article 81 (Guardianship)
`O Other Mental Hygiene (specify):
`O Other SpecialProceeding (specify):
`
`NATURE OF ACTION OR PROCEEDING
`COMMERICIAL
`O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.)
`O Contract
`Q Insurance (where insurance company is a party, except arbitration)
`O UCC(includes salesand negotiable instruments)
`O Other Commercial (specify):
`NOTE:For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d),
`complete und ottach the COMMERCIALDIVISIONRJIADDENDUM (UCS-84OC).
`REALPROPERTY
`Specify how many properties the application includes:
`Q Condemnation
`O Mortgage Foreclosure(specify):
`Property Address:
`NOTE:For Mortgage Foreclosureactions involving a one to four-family,
`owner-occupied residential property or owner-occupied condominium,
`complete ond attach the FORECLOSURERJIADDENDUM (UCS-84OF).
`O TaxCertiorari
`Q in roreclosure
`Q Other ReafProperty (specify):
`OTHERMATTERS
`O Certificate of Incorporation/Dissolution
`Q Emergency Medical Treatment
`O HabeasCorpus
`O I ocal Court Appeaf
`O Mechanic's Lien
`O Name Change
`Q P stoi Permit Revocation Hearing
`O Saleor Financeof Religious/Not-for-Profit Property
`O Other (specify):
`STATUS OF ACTION OR PROCEEDiNG
`
`Q Residential
`
`Q Commercial
`
`[see NOTEin COMMERCIALsection]
`
`information where indicated.
`
`07/09/2020
`08/2S/2020
`
`Answer YESor NO for every question and enter additional
`YES
`NO
`@
`Hasa summons and complaint or summons with notice been filed?
`If yes, date filed:
`Q
`O
`O
`If yes, date served:
`Hasa summons and complaint or summons with notice been served?
`Q
`@ If yes,judgment date:
`Is this action/proceeding being filed post-judgment?
`NATURE OF JUDICIAL iNTERVENTION
`Check one box only and enter additional
`information where indicated.
`Q infant's Compromise
`Q E×treme RiskProtection Order Application
`O Note of issue/Certificate of Readiness
`Notice of Medical Dental or Podiatnc Malpractice
`Notice of Motion
`O Notice of Petition
`O Order to Show Cause
`O Other Fx Parte Application
`Q poor PersonApplication
`Q Requestfor Preliminary Conference
`O Revdential Mortgage Foreclosure Settlement Conference
`O Wnt of HabeasCorpus
`O Other (specify): _____
`
`___
`
`Date IssueJoined: __
`Relief Requested:
`Relief Requested:
`Relief Requested: __ _
`Relief Requested: ___
`
`Esmiss
`
`Return Date:
`Return Date:
`Return Date:
`
`_____
`
`_ _______
`
`___
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`1 of 2
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`

`

`FILED: ORLEANS COUNTY CLERK 09/14/2020
`NYSCEF DOC. NO. 3
`
`INDEX NO. 20-46602
`
`RECEIVED NYSCEF: 02/09/2022
`
`RELATED CASES
`
`CaseTitle
`
`cases, list any related criminal or Family Court cases.
`List any related actions. For Matrimonial
`If additione! space is required, complete and attach the RJI ADDENDUM (UCS-840A).
`Index/Case Number
`Court
`Judge (if assigned)
`
`If none,
`
`leave blank.
`
`|Rdaticmhip to instant case
`
`check the "Un-Rep" box and enter
`For parties without an attorney,
`the party's address, phone number and email
`If additional
`space is required, complete and attach the RJl ADDENDUM (UCS-840A).
`Atteme•;: and Unrepresented Litigants
`For represented parties, provide attorney's name, firm name, address, phone and
`email. For unrepresented parties, provide party's address, phone and email.
`
`in the space provided.
`
`Issuejoined
`Insurance Carriers
`For each defendant, For each defendant,
`indicate if issue has
`indicate insurance
`been joined.
`carrier, if applicable.
`
`PARTIES
`
`Un- Parties
`Rep List parties in sameorder as listed in the
`caption and indicate roles (e.g., plaintiff,
`defendant, 3'dparty plaintiff, etc.)
`AB 511 Doe
`Plaintiff
`LyndonvilleCentral SchoolDistrict MarkGuglielmi.Esq.Websterszanyi,LLP,1400LibertyBuilding,Buffalo,NY14202
`(716)342-2800:mguglielmi@websterszanyi.com
`Defendant
`Lyndonville Elementary School MarkGuglielmi,Esq.WebsterSzanyi,LLP,1400LibertyBuilding,Buffalo,NY14202
`(716)842-2800;mguglielmi@websterszanyi.com
`Defendant
`
`LeahCostanzo,Esq..steveBoyd,PC,40NorthForestRoad,Williamsville.NY14221
`(716)400-0000;Icostanzo@steveboyd.com
`
`Name:
`Role(s):
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`Name:
`Role(s):
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`Name:
`Role(s):
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`Name:
`Role(s):
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`Name:
`Role(s):
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`Name
`Role(s):
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`Name:
`Role(s):
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`Name:
`Roe(s):
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`Name
`Role(s):
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`Name:
`Role(s):
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`Name:
`Role(s):
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`Name:
`Role(s):
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`@ YES ® NO
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`@ YES O NO
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`Q YES O NO
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`O YES Q NO
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`O YES O NO
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`O YES O NO
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`O YES O NO
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`Q YES Q NO
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`O YES O NO
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`O YES Q NO
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`O YES O NO
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`Q YES O NO
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`Q YES O NO
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`O YES O NO
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`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.
`
`3013547
`Registration
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`Number
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`Attorney
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`2 of 2
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`Signature
`
`Mark E. Guglielmi
`Print Name
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`