FILED: SUFFOLK COUNTY CLERK 11/16/2018 12:30 PM
`NYSCEF DOC. NO. 7
`REQUEST FOR JUDICIAL INTERVENTION
`
`INDEX NO. 618743/2018
`
`RECEIVED NYSCEF: 11/16/2018
`For Court Clerk Use Only:
`
`UCS-840 (7/2012)
`Suffolk Supreme COURT, COUNTY OF Suffolk
`
`Index No: 618743/2018
`
`Date Index Issued: 09/27/2018
`
`CAPTION:
`AE & LY Medical Associates, PLLC
`
`Enter the complete case caption. Do not use et al or et ano. If more space is required,
`attach a caption rider sheet.
`
`IAS Entry Date
`
`Judge Assigned
`
`RJI Date
`
`-against-
`Fidelis Care New York
`
`Plaintiff(s)/Petitioner(s)
`
`Defendant(s)/Respondent(s)
`
`NATURE OF ACTION OR PROCEEDING:
`MATRIMONIAL
`☐ Contested
`NOTE: For all Matrimonial actions where the parties have children under the
`age of 18, complete and attach the MATRIMONIAL RJI Addendum. For
`Uncontested Matrimonial actions, use RJI form UD-13.
`
`TORTS
`
`Asbestos
`
`Breast Implant
`
`Environmental:
`
`Medical, Dental, or Podiatric Malpractice
`
`Motor Vehicle
`
`Products Liability:
`
`Other Negligence:
`
`Other Professional Malpractice:
`
`Other Tort:
`
`☐☐☐☐☐☐☐☐☐
`
`Check ONE box only and specify where indicated.
`COMMERCIAL
`☐ Business Entity (including corporations, partnerships, LLCs, etc.)
`☒ Contract
`☐ Insurance (where insurer is a party, except arbitration)
`☐ UCC (including sales, negotiable instruments)
`☐ Other Commercial:
`NOTE: For Commercial Division assignment requests [22 NYCRR § 202.70(D)],
`complete and attach the COMMERCIAL DIV RJI Addendum.
`REAL PROPERTY:
`☐ Condemnation
`☐ Mortgage Foreclosure:
`Property Address:
`NOTE: For Mortgage Foreclosure actions involving a one- to four-family, owner-
`occupied, residential property, or an owner-occupied condominium, complete and
`attach the FORECLOSURE RJI Addendum.
`
`How many properties does the application include?
`
`☐ Residential
`
`☐ Commercial
`
`Block:
`
`Lot:
`
`Tax Certiorari - Section:
`Tax Foreclosure
`Other Real Property:
`
`☐☐☐
`
`SPECIAL PROCEEDINGS
`☐ CPLR Article 75 (Arbitration)     [see NOTE under Commercial]
`☐ CPLR Article 78 (Body or Officer)
`☐ Election Law
`☐ MHL Article 9.60 (Kendra's Law)
`☐ MHL Article 10 (Sex Offender Confinement-Initial)
`☐ MHL Article 10 (Sex Offender Confinement-Review)
`☐ MHL Article 81 (Guardianship)
`☐ Other Mental Hygiene:
`☐
`Other Special Proceeding:
`
`Answer YES or NO for EVERY question AND enter additional information where indicated.
`YES NO
`☒ ☐
`☒ ☐
`☐ ☒
`
`If yes, date filed: 09/26/2018
`If yes, date served: 10/04/2018
`If yes, judgment date:
`
`1 of 2
`
`OTHER MATTERS
`☐ Certificate of Incorporation/Dissolution     [see NOTE under Commercial]
`☐ Emergency Medical Treatment
`☐ Habeas Corpus
`☐ Local Court Appeal
`☐ Mechanic's Lien
`☐ Name Change
`☐ Pistol Permit Revocation Hearing
`☐ Sale or Finance of Religious/Not-for-Profit Property
`☐ Other:
`STATUS OF ACTION OR PROCEEDING:
`
`Has a summons and complaint or summons w/notice been filed?
`Has a summons and complaint or summons w/notice been served?
`Is this action/proceeding being filed post-judgment?
`
`

`

`INDEX NO. 618743/2018
`
`Date Issue Joined:
`Dismiss
`
`12/21/2018
`
`Return Date:
`Return Date:
`Return Date:
`
`FILED: SUFFOLK COUNTY CLERK 11/16/2018 12:30 PM
`NATURE OF JUDICIAL INTERVENTION:
`NYSCEF DOC. NO. 7
`RECEIVED NYSCEF: 11/16/2018
`Check ONE box only AND enter additional information where indicated.
`Infant's Compromise
`Note of Issue and/or Certificate of Readiness
`Notice of Medical, Dental, or Podiatric Malpractice
`Notice of Motion
`Relief Sought:
`Notice of Petition
`Relief Sought:
`Order to Show Cause
`Relief Sought:
`Other Ex Parte Application
`Relief Sought:
`Poor Person Application
`Request for Preliminary Conference
`Residential Mortgage Foreclosure Settlement Conference
`Writ of Habeas Corpus
`Other:
`RELATED CASES:
`
`☐☐☐☒☐ ☐☐ ☐☐☐☐☐
`
`Case Title
`
`List any related actions. For Matrimonial actions, include any related criminal and/or Famiy Court cases. If
`additional space is required, complete and attach the RJI Addendum. If none, leave blank.
`Index/Case No.
`Court
`Judge (if assigned)
`
`Relationship to Instant Case
`
`PARTIES:
`
`Parties:
`
`For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail
`address in space provided. If additional space is required, complete and attach the RJI Addendum.
`Attorneys and/or Unrepresented Litigants:
`
`Un-
`Rep
`
`List parties in caption order and indicate
`party role(s) (e.g., defendant; 3rd-party
`plaintiff).
`
`Provide attorney name, firm name, business address, phone number and e-
`mail address of all attorneys that have appeared in the case. For
`unrepresented litigants, provide address, phone number and e-mail address.
`
`☐
`
`☐
`
`Name: AE & LY Medical Associates, PLLC
`
`EDWARD BLODNICK, BLODNICK, FAZIO & CLARK, 1325 FRANKLIN AVE
`STE 555 , GARDEN CITY, NY 11530, eblodnick@blodnickfaziolaw.com
`
`Role(s): Plaintiff/Petitioner
`
`Name: Fidelis Care New York
`
`Role(s): Defendant/Respondent
`
`BINNY SETH, 2338 Surrey Lane , Baldwin, NY 11510, 5163225206,
`BinnySeth@BinnySethEsq.com
`
`Insurance Carrier(s):
`
`Issue
`Joined
`(Y/N):
`
`NO
`
`NO
`
`Name:
`
`☐ Role(s):
`
`Name:
`
`☐ Role(s):
`
`Name:
`
`☐ Role(s):
`
`I AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE
`ARE AND HAVE BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL
`INTERVENTION PREVIOUSLY BEEN FILED IN THIS ACTION OR PROCEEDING.
`
`Dated:
`
`11/16/2018
`
`5093620
`ATTORNEY REGISTRATION NUMBER
`
`This form was generated by NYSCEF
`2 of 2
`
`BINNY SETH
`SIGNATURE
`
`BINNY SETH
`PRINT OR TYPE NAME
`
`