Preview
= INDEX NO. 653404/2014
NYSCEF DOC. NO. 14 ECEIVED_NYSCEF 11/24/2014
REQUEST FOR JUDICIAL INTERVENTION eUse
Ucs.840 (7/2012)
Supreme COURT, COUNTY OF. New York
Index No: Date Index Issued
the:
IMAPFRE INSURANCE COMPANY OF NEW YORK
Plalntiff(s)/Petitioner(s)
gainst-
ETERNITY ACUPUNCTURE, P.C. a/a/o TATYANA SAGOLOVICH
Defendant(s)/Respondent(s)
KO) can
MATRIMONIAL. COMMERCIAL... a
(co Contested © Business Entity (including corporations, partnerships, LLCs, etc)
NOTE; For ali Matrimonial actlons where the parties have children under © contract
the age of 18, complete and attach the MATRIMONIAL Rul Addendum © Insurance (where insurer Is a party, except arbitration)
For Uncontested Matrimonial actions,use Rall form UD. 13. © UCC (including sales, negotiable Instruments)
FORTS as © other Commercial
(specify)
© Asbestos
© Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR §
© Environmental: 202.70(d)], complete and attach the COMMERCIAL DIVRul Addendum
(specify) REAL PROPERTY. Hoc: operties6 ‘thes
© Medical, Dental, or Podiatric Malpractice Condemnation
© Motor Vehicle © Mortgage Foreclosure fepecly): © Residential © commercial
© Produets Liability: Properly Address
(epeaty) Straet Address city State ap
© other Negligence: NOTE: For Mortgage Foreclosure actions Involving a one- to four-family,
(epectty) owner-occupied, residential property, or an owner-occupied
© Other Professional Malpractice: condominium, complete and attach the FORECLOSURE RWI Addendum.
(spoalfy) © Tax Cartiorari - Section: Block: Lot:
© other Tort © Tax Foreclosure
(specity) © other Real Property:
(eee)
[OTHER MATTERS. so
© Centificate of incorporation/Dissolution ieee NOTE under Gonunercal| ISPEGIAL PROCEEDINGS. = sa
© Emergency Medical Treatment @ CPLR Article 75 (Arbitration) [see NOTE ‘under Gommerclall
© Habeas Corpus © CPLR Article 78 (Body or Officer)
Local Court Appeal © Election taw
© Mechanic's Lien © MHL Article 9.60 (Kendra's Law)
© Name Change © MHL Ariicle 10 (Sex Offender Confinement-nitlal)
© Pistol Permit Revocation Hearing © MHL Articie 10 (Sex Offender Confinement-Review)
© Sale or Finance of Rellglous/Not-for-Proflt Property © MHL Article 81 (Guardianship)
© other: © other Mental Hygiene:
{epecify) (specify)
© Other Special Proceeding:
(specity)
allot AND -enler-addilichal info
Lyes [No |
Has a summons and complaint or summons wfnotice been filed? Oo © Ifyes, date filed:
Has a summons and complaint or summons w/notice bean served? Oo © Ifyes, date served:
Is this action/proceeding being filed postjudgment? oO ® IFyes, Judgment date:
=e
ec
O Infant's Compromise
Note of issue and/or Certificate of Readiness
© Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined:
© Nolice of Matton Relief Sought: Retum Date:
© Notice of Petition Reliof Soug! rt; Vacate- Declsfon/Order/Judament/Award Return Date: 12/16/2014
© order to Show Cause Relisf Sough Retum Date:
© Other &x Parte Application Relist Sough!
© Poor Person Application
© Request for Preliminary Conference
© Residential Mortgage Foreclosure Settlement Conference
© Writ of Habeas Corpus
© Other (specity):
a aie
EMatrien india EGourt
RE! D- CASE: addilional: au
Case Title: IndexiCase.No: Cou -| Judge (if assigned) reaiatonattp to Instant Case
RN
ae
Parties: Attorneys and/or tnrenresented Litigan
Issue
Un- List parties in-caption order and Provide attorney name, firm name, business address, phone number and e-mall soined
Ansurance
Rep Indicate party rola(s)-(e.g. defendant; address of all attorneys that have appeared In the case. For unrepresented Levi): “Garerte):
.
Srd-party plaintiff). litigants, provide address, phone number and e-mail address, 5
IMAPFREInsurance Company of New York Bhapiro Last Name
Nathan,
First Name. ves
Bruno, Gerbino & Sorlano, LLP
First Name Firm Name
Primary Role:
145 Broadhollow Road, Suite 220 Melville New York 14747
Petitioner ot Address ty SI zip
‘Secondary Role (if any): Kno
[6311 s90.c010 +1 (631) 398-5497 nshapiro@bgslaw-ny.com
Eternity Acupuncture, P.C.
ast Name Last Name Firat Name
(ves
la‘a/o Tatyana Sagolovich
Firet Name Firm Name
El Primary Role:
34-22 35th Avenue Flushing New York. 11354
‘Street Address ony State Zip
Secondary Role (If any}: Ke)NO
Phone Fax ema
Last Name Last Name First Name
Kyes
First Namo Firm Name.
Cj Primary Role:
Street Addrese city State zip
Secondary Role (if any): Kno
Phono Fax, e-mall
Last Name Last Name First Name
yes
Cl Firat Name
Primary Role:
Firm Namo
Btroot Addrass, chy State zip
Socondary Role (if any): Kno
Phone Fax e-mall
| 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
ge
THIS ACTION OR PROCEEDING.
Dated: 11/04/2014
yun SIGNATURE
5018262 Nathan M. Shapiro
ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME
d'T'1 ‘ONVI¥OS * ONIGUaD ‘ONNUg
Year 20 14
SUPREME COURT OF THES STATE OF NEW YORK
qounTY OF NEW YORK
t
ares INS. CO. OF NEW YORK
| Petitioner,
I: -against-
i rerntry ACUPUNCTURE, P.C. / TATYANA SAGOLOVICH
Respondent(s).
Request for Judicial Intervention
Bruno, Gersino & Soriano, LLP
Petitioner(s)
Attorney!
Offic 2and Post Office Address
445 BROAD HOLLOW ROAD « SUITE 220 70 HILLTOP ROAD * SUITE 1005
MELVILLE, NEW YORK 11747 RAMSEY, NEW JERSEY 07446
(631) 390-0010 (201) 995-1304
AA109-3281B
FILE #
|
\ Pursuant to 22 NYCRR 130-1.1-a, the undersigned, an attorney admitted to practice in the courts of New York
| State, certifies that, to the best of my knowledge, information and belief, formed after an inquiry reasonable under
f the circumstances, the presentation of this document or the contenjipns cont, therein are not frivolous.
| Dated. November 204... Signature.......
Print Signer’s Name.......... NATHAN. SHAPIRO,.
| Service ofa copy of the within is hereby admitted.
Dated,
Attorney(s) for
}
it
it Sir: Please take notice
CINOTIGE OF ENTRY
that the within is a (certified) true copy of a
duly entered in the office of the clerk of the within named court on 20
LINOTICE OF SETTLEMENT
that an order of which the within is a true copy will be presented for
j settlement to the HON. ‘one of the judges.
I
lof the within named Court, at
i on the day of 20 at M
Dated,
Yours, etc.
Preview
= INDEX NO. 653404/2014 NYSCEF DOC. NO. 14 ECEIVED_NYSCEF 11/24/2014 REQUEST FOR JUDICIAL INTERVENTION eUse Ucs.840 (7/2012) Supreme COURT, COUNTY OF. New York Index No: Date Index Issued the: IMAPFRE INSURANCE COMPANY OF NEW YORK Plalntiff(s)/Petitioner(s) gainst- ETERNITY ACUPUNCTURE, P.C. a/a/o TATYANA SAGOLOVICH Defendant(s)/Respondent(s) KO) can MATRIMONIAL. COMMERCIAL... a (co Contested © Business Entity (including corporations, partnerships, LLCs, etc) NOTE; For ali Matrimonial actlons where the parties have children under © contract the age of 18, complete and attach the MATRIMONIAL Rul Addendum © Insurance (where insurer Is a party, except arbitration) For Uncontested Matrimonial actions,use Rall form UD. 13. © UCC (including sales, negotiable Instruments) FORTS as © other Commercial (specify) © Asbestos © Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR § © Environmental: 202.70(d)], complete and attach the COMMERCIAL DIVRul Addendum (specify) REAL PROPERTY. Hoc: operties6 ‘thes © Medical, Dental, or Podiatric Malpractice Condemnation © Motor Vehicle © Mortgage Foreclosure fepecly): © Residential © commercial © Produets Liability: Properly Address (epeaty) Straet Address city State ap © other Negligence: NOTE: For Mortgage Foreclosure actions Involving a one- to four-family, (epectty) owner-occupied, residential property, or an owner-occupied © Other Professional Malpractice: condominium, complete and attach the FORECLOSURE RWI Addendum. (spoalfy) © Tax Cartiorari - Section: Block: Lot: © other Tort © Tax Foreclosure (specity) © other Real Property: (eee) [OTHER MATTERS. so © Centificate of incorporation/Dissolution ieee NOTE under Gonunercal| ISPEGIAL PROCEEDINGS. = sa © Emergency Medical Treatment @ CPLR Article 75 (Arbitration) [see NOTE ‘under Gommerclall © Habeas Corpus © CPLR Article 78 (Body or Officer) Local Court Appeal © Election taw © Mechanic's Lien © MHL Article 9.60 (Kendra's Law) © Name Change © MHL Ariicle 10 (Sex Offender Confinement-nitlal) © Pistol Permit Revocation Hearing © MHL Articie 10 (Sex Offender Confinement-Review) © Sale or Finance of Rellglous/Not-for-Proflt Property © MHL Article 81 (Guardianship) © other: © other Mental Hygiene: {epecify) (specify) © Other Special Proceeding: (specity) allot AND -enler-addilichal info Lyes [No | Has a summons and complaint or summons wfnotice been filed? Oo © Ifyes, date filed: Has a summons and complaint or summons w/notice bean served? Oo © Ifyes, date served: Is this action/proceeding being filed postjudgment? oO ® IFyes, Judgment date: =e ec O Infant's Compromise Note of issue and/or Certificate of Readiness © Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined: © Nolice of Matton Relief Sought: Retum Date: © Notice of Petition Reliof Soug! rt; Vacate- Declsfon/Order/Judament/Award Return Date: 12/16/2014 © order to Show Cause Relisf Sough Retum Date: © Other &x Parte Application Relist Sough! © Poor Person Application © Request for Preliminary Conference © Residential Mortgage Foreclosure Settlement Conference © Writ of Habeas Corpus © Other (specity): a aie EMatrien india EGourt RE! D- CASE: addilional: au Case Title: IndexiCase.No: Cou -| Judge (if assigned) reaiatonattp to Instant Case RN ae Parties: Attorneys and/or tnrenresented Litigan Issue Un- List parties in-caption order and Provide attorney name, firm name, business address, phone number and e-mall soined Ansurance Rep Indicate party rola(s)-(e.g. defendant; address of all attorneys that have appeared In the case. For unrepresented Levi): “Garerte): . Srd-party plaintiff). litigants, provide address, phone number and e-mail address, 5 IMAPFREInsurance Company of New York Bhapiro Last Name Nathan, First Name. ves Bruno, Gerbino & Sorlano, LLP First Name Firm Name Primary Role: 145 Broadhollow Road, Suite 220 Melville New York 14747 Petitioner ot Address ty SI zip ‘Secondary Role (if any): Kno [6311 s90.c010 +1 (631) 398-5497 nshapiro@bgslaw-ny.com Eternity Acupuncture, P.C. ast Name Last Name Firat Name (ves la‘a/o Tatyana Sagolovich Firet Name Firm Name El Primary Role: 34-22 35th Avenue Flushing New York. 11354 ‘Street Address ony State Zip Secondary Role (If any}: Ke)NO Phone Fax ema Last Name Last Name First Name Kyes First Namo Firm Name. Cj Primary Role: Street Addrese city State zip Secondary Role (if any): Kno Phono Fax, e-mall Last Name Last Name First Name yes Cl Firat Name Primary Role: Firm Namo Btroot Addrass, chy State zip Socondary Role (if any): Kno Phone Fax e-mall | 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 ge THIS ACTION OR PROCEEDING. Dated: 11/04/2014 yun SIGNATURE 5018262 Nathan M. Shapiro ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME d'T'1 ‘ONVI¥OS * ONIGUaD ‘ONNUg Year 20 14 SUPREME COURT OF THES STATE OF NEW YORK qounTY OF NEW YORK t ares INS. CO. OF NEW YORK | Petitioner, I: -against- i rerntry ACUPUNCTURE, P.C. / TATYANA SAGOLOVICH Respondent(s). Request for Judicial Intervention Bruno, Gersino & Soriano, LLP Petitioner(s) Attorney! Offic 2and Post Office Address 445 BROAD HOLLOW ROAD « SUITE 220 70 HILLTOP ROAD * SUITE 1005 MELVILLE, NEW YORK 11747 RAMSEY, NEW JERSEY 07446 (631) 390-0010 (201) 995-1304 AA109-3281B FILE # | \ Pursuant to 22 NYCRR 130-1.1-a, the undersigned, an attorney admitted to practice in the courts of New York | State, certifies that, to the best of my knowledge, information and belief, formed after an inquiry reasonable under f the circumstances, the presentation of this document or the contenjipns cont, therein are not frivolous. | Dated. November 204... Signature....... Print Signer’s Name.......... NATHAN. SHAPIRO,. | Service ofa copy of the within is hereby admitted. Dated, Attorney(s) for } it it Sir: Please take notice CINOTIGE OF ENTRY that the within is a (certified) true copy of a duly entered in the office of the clerk of the within named court on 20 LINOTICE OF SETTLEMENT that an order of which the within is a true copy will be presented for j settlement to the HON. ‘one of the judges. I lof the within named Court, at i on the day of 20 at M Dated, Yours, etc.