{"@context":"https://schema.org","@type":"DigitalDocument","altText":"Comment attachment by Anonymous","alternateName":"22-RJI_AMENDED.pdf","caption":"","contentUrl":"https://lucycraig.blog/media/572/raw","datePublished":"2026-10-21T20:07:57+00:00","description":"","encodingFormat":"application/pdf","identifier":"572","isAccessibleForFree":true,"machineReadable":{"json":"https://lucycraig.blog/media/572/index.json","markdown":"https://lucycraig.blog/media/572/index.md"},"name":"Comment attachment by Anonymous","ocrStatus":"ready","ocrText":"--- Page 1 ---\nQ\nQ\nQOQO\nOQ\nQQOQ\nQ\nQO\nO\nQ\nOQ\nO\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nO\nQ\nQ\nQ\nO\nQ\nO\nQ\nQ\n@\nQ\nQ\n@\nQ\n@\nQQQQQQ\nOOOOOO\nREQUEST FOR JUDICIAL INTERVENTION \nUCS-840 \n(rev. 12/16/2024)\n_______________ COURT, COUNTY OF _______________ \nIndex No: _______________ \nDate Index Issued: _______________ \nFor Court Use Only: \nCAPTION \nEnter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. \nIAS Entry Date \nPlaintiff(s)/Petitioner(s) \nJudge Assigned \n-against- \nRJI Filed Date \nDefendant(s)/Respondent(s) \nNATURE OF ACTION OR PROCEEDING \nCheck only one box and specify where indicated. \nCOMMERICIAL \nMATRIMONIAL \nBusiness Entity (includes corporations, partnerships, LLCs, LLPs, etc.) \nContested \nContract \nNOTE: If there are children under the age of 18, complete and attach the \nInsurance (where insurance company is a party, except arbitration) \nMATRIMONIAL RJI ADDENDUM (UCS-840M). \nUCC (includes sales and negotiable instruments) \nFor Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13). \nOther Commercial (specify): _______________________________________________ REAL PROPERTY \nSpecify how many properties the application includes: _______ \nNOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), \nCondemnation \ncomplete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). \nMortgage Foreclosure (specify):  \nResidential    \nCommercial \nTORTS \nProperty Address: ____________________________________________________ \nAsbestos \nNOTE: For Mortgage Foreclosure actions involving a one to four-family, \nEnvironmental (specify): __________________________________________________ \nowner-occupied residential property or owner-occupied condominium, \nMedical, Dental or Podiatric Malpractice \ncomplete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F). \nMotor Vehicle \nPartition \nProducts Liability (specify): ________________________________________________ \nNOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P). \nOther Negligence (specify): ________________________________________________ \nTax Certiorari (specify): \nSection:________ Block:________ Lot:________ \nOther Professional Malpractice (specify): _____________________________________ \nTax Foreclosure \nOther Tort (specify): ______________________________________________________ \nOther Real Property (specify): __________________________________________ \nSPECIAL PROCEEDINGS \nOTHER MATTERS \nChild-Parent Security Act (specify):  \nAssisted Reproduction   \nSurrogacy Agreement \nCertificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] \nCPLR Article 75 \u2013 Arbitration [see NOTE in COMMERCIAL section] \nEmergency Medical Treatment \nCPLR Article 78 \u2013 Proceeding against a Body or Officer \nHabeas Corpus \nElection Law \nLocal Court Appeal \nExtreme Risk Protection Order \nMechanic\u2019s Lien \nMHL Article 9.60 \u2013 Kendra\u2019s Law \nName Change/Sex Designation Change \nMHL Article 10 \u2013 Sex Offender Confinement (specify):  \nInitial    \nReview \nPistol Permit Revocation Hearing \nMHL Article 81 (Guardianship) \nSale or Finance of Religious/Not-for-Profit Property \nOther Mental Hygiene (specify): ____________________________________________ \nOther (specify): ______________________________________________________ \nOther Special Proceeding (specify): _________________________________________ \nSTATUS OF ACTION OR PROCEEDING \nAnswer YES or NO for every question and enter additional information where indicated. \nYES \nNO \nHas a summons and complaint or summons with notice been filed? \nIf yes, date filed: \n___________________ \nHas a summons and complaint or summons with notice been served? \nIf yes, date served: \n___________________ \nIs this action/proceeding being filed post-judgment? \nIf yes, judgment date: ___________________ \nNATURE OF JUDICIAL INTERVENTION \nCheck one box only and enter additional information where indicated. \nInfant\u2019s Compromise \nExtreme Risk Protection Order Application \nNote of Issue/Certificate of Readiness \nNotice of Medical, Dental or Podiatric Malpractice \nDate Issue Joined: ___________________ \nNotice of Motion \nRelief Requested: ______________________________ \nReturn Date: ___________________ \nNotice of Petition \nRelief Requested: ______________________________ \nReturn Date: ___________________ \nOrder to Show Cause \nRelief Requested: ______________________________ \nReturn Date: ___________________ \nOther Ex Parte Application \nRelief Requested: ______________________________ \nPartition Settlement Conference \nRequest for Preliminary Conference \nResidential Mortgage Foreclosure Settlement Conference \nWaiver of Court Costs, Fees, and Expenses \nWrit of Habeas Corpus \nOther (specify): ____________________________________________________________________________ \nSUPREME\nNEW YORK\n161704\n09/17/2026\nJANE DOE,\nCORNELL UNIVERSITY, INC., CHI PHI CHAPTER HOUSE ASSOCIATION, CHI PHI \nFRATERNITY, INC., CHI PHI EDUCATIONAL TRUST, ALPHA BETA HOUSE \nCORPORATION OF DELTA DELTA DELTA, DELTA DELTA DELTA SORORITY, \nZAREEN \nSexual Assault\n09/16/2026\nName Change\n10/23/2026\nFILED: NEW YORK COUNTY CLERK 09/30/2026 01:25 PM\nINDEX NO. 161704/2026\nNYSCEF DOC. NO. 22\nRECEIVED NYSCEF: 09/30/2026\n1 of 3\n\n--- Page 2 ---\nO\nO\nQ\n@\n@\n@\nRELATED CASES \nList any related actions.  For Matrimonial cases, list any related criminal or Family Court cases.  If none, leave blank. \nIf additional space is required, complete and attach the RJI ADDENDUM (UCS-840A). \nCase Title \nIndex/Case Number \nCourt \nJudge (if assigned) \nRelationship to instant case \nPARTIES \nFor parties without an attorney, check the \u201cUn-Rep\u201d box and enter the party\u2019s address, phone number and email in the space provided. \nIf additional space is required, complete and attach the RJI ADDENDUM (UCS-840A). \nUn-\nRep \nParties \nList parties in same order as listed in the \ncaption and indicate roles (e.g., plaintiff, \ndefendant, 3rd party plaintiff, etc.) \nAttorneys and Unrepresented Litigants \nFor represented parties, provide attorney\u2019s name, firm name, address, phone and \nemail.  For unrepresented parties, provide party\u2019s address, phone and email. \nIssue Joined \nFor each defendant, \nindicate if issue has \nbeen joined. \nInsurance Carriers \nFor each defendant, \nindicate insurance \ncarrier, if applicable. \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nI AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, \nEXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. \nDated: ___________________ \n_______________________________________________________ \nSignature \n________________________________________________________ \n_______________________________________________________ \nAttorney Registration Number \nPrint Name \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nJane Doe\nPlaintiff\nETHAN COHEN, RHEINGOLD GIUFFRA RUFFO \nPLOTKIN &\nHELLMAN LLP 551 5TH AVE FL 29\nNEW\n \nCornell University, Inc.\nDefendant\n373 Pine Tree Road, Ithaca, NY  14850\n \nChi Phi Chapter HouseAss\nDefendant\nP.O. Box 1600, Ithaca, NY  14850\n \nChi Phi Fraternity, Inc.\nDefendant\n573 Main St.\nGeneva, NY 14456\n \nChi Phi Educational Trust\nDefendant\n885 Woodstock Rd., Ste. 430-389\nRoswell, GA 30075\n \nAlpha Beta House Corpo\nDefendant\n410 E UPLAND, ITHACA, NY14850\n \nDelta Delta Delta Sorority\nDefendant\n14951 Dallas Pkwy., Ste. 500\nDallas, TX 75254\n \nZareen Enterprise LLC d/\nDefendant\n409 EDDY ST., ITHACA, NY, 14850\n \nMatthew Ingalls\nDefendant\n48 TRILLIUM RD, FAIRFIELD, CT 06824\n \nJohnathan Newell\nDefendant\n12944 Stonebrook Dr.\nDavie, FL 33330\n \nWinston Lee\nDefendant\nCornell University- Martin Y. Tang Welcome \nCenter\n616 Th\nt\nA\nIth\nNY 14853\n \nGillio Lopes\nDefendant\n4402 Saul Rd.\nKensington, MD 20895\n \nDiego Sarabia\nDefendant\n7 Short Dr.\nBethel, CT 06801\n \nScott Norris\nDefendant\n5540 Wells Curtice Rd.\nCanandaigua, NY 14424\n \nScott Ketzschmar\nDefendant\n8814 Meisner Rd.\nCasco, MI 48064\n \n09/30/2026\n6213144\nETHAN J COHEN\nFILED: NEW YORK COUNTY CLERK 09/30/2026 01:25 PM\nINDEX NO. 161704/2026\nNYSCEF DOC. NO. 22\nRECEIVED NYSCEF: 09/30/2026\n2 of 3\n\n--- Page 3 ---\nRequest for Judicial Intervention Addendum\nIndex No: ________________________\nCOUNTY OF__________________________\n_______________________COURT,\nFor use when additional space is needed to provide party or related case information.\nFor parties without an attorney, check \"Un-Rep\" box AND enter party address, phone number and e-mail address in \"Attorneys\" space.\nPARTIES:\nInsurance Carrier(s):\n(Y/N):\nJoined\nIssue\nAttorneys and/or Unrepresented Litigants:\nParties: \nRep\nUn-\nlitigants, provide address, phone number and e-mail address.\naddress of all attorneys that have appeared in the case.  For unrepresented\nProvide attorney name, firm name, business address, phone number and e-mail\n3rd-party plaintiff).\nindicate party role(s) (e.g. defendant;\nList parties in caption order and\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nList any related actions.  For Matrimonial actions, include any related criminal and/or Family Court cases.\nRELATED CASES:\nRelationship to Instant Case\nJudge (if assigned)\nCourt\nIndex/Case No.\nCase Title\nUCS-840A (7/2012)\nZip\nState\nZip\nState\nZip\nState\nZip\nState\nZip\nState\nZip\nState\nSupreme\nNew York\n161704/2026\nDoe\nJohn\nDefendant\n \nDoe\nJohn\nDefendant\n \nDoe\nJohn\nDefendant\n \nPetito\nOrazio\nDefendant\nPetito\nOrazio\n107 Jessup Rd\nIthaca\nNew York\n14850\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nPrint Form\nFILED: NEW YORK COUNTY CLERK 09/30/2026 01:25 PM\nINDEX NO. 161704/2026\nNYSCEF DOC. NO. 22\nRECEIVED NYSCEF: 09/30/2026\n3 of 3","text":"--- Page 1 ---\nQ\nQ\nQOQO\nOQ\nQQOQ\nQ\nQO\nO\nQ\nOQ\nO\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nQ\nO\nQ\nQ\nQ\nO\nQ\nO\nQ\nQ\n@\nQ\nQ\n@\nQ\n@\nQQQQQQ\nOOOOOO\nREQUEST FOR JUDICIAL INTERVENTION \nUCS-840 \n(rev. 12/16/2024)\n_______________ COURT, COUNTY OF _______________ \nIndex No: _______________ \nDate Index Issued: _______________ \nFor Court Use Only: \nCAPTION \nEnter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. \nIAS Entry Date \nPlaintiff(s)/Petitioner(s) \nJudge Assigned \n-against- \nRJI Filed Date \nDefendant(s)/Respondent(s) \nNATURE OF ACTION OR PROCEEDING \nCheck only one box and specify where indicated. \nCOMMERICIAL \nMATRIMONIAL \nBusiness Entity (includes corporations, partnerships, LLCs, LLPs, etc.) \nContested \nContract \nNOTE: If there are children under the age of 18, complete and attach the \nInsurance (where insurance company is a party, except arbitration) \nMATRIMONIAL RJI ADDENDUM (UCS-840M). \nUCC (includes sales and negotiable instruments) \nFor Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13). \nOther Commercial (specify): _______________________________________________ REAL PROPERTY \nSpecify how many properties the application includes: _______ \nNOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), \nCondemnation \ncomplete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). \nMortgage Foreclosure (specify):  \nResidential    \nCommercial \nTORTS \nProperty Address: ____________________________________________________ \nAsbestos \nNOTE: For Mortgage Foreclosure actions involving a one to four-family, \nEnvironmental (specify): __________________________________________________ \nowner-occupied residential property or owner-occupied condominium, \nMedical, Dental or Podiatric Malpractice \ncomplete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F). \nMotor Vehicle \nPartition \nProducts Liability (specify): ________________________________________________ \nNOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P). \nOther Negligence (specify): ________________________________________________ \nTax Certiorari (specify): \nSection:________ Block:________ Lot:________ \nOther Professional Malpractice (specify): _____________________________________ \nTax Foreclosure \nOther Tort (specify): ______________________________________________________ \nOther Real Property (specify): __________________________________________ \nSPECIAL PROCEEDINGS \nOTHER MATTERS \nChild-Parent Security Act (specify):  \nAssisted Reproduction   \nSurrogacy Agreement \nCertificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] \nCPLR Article 75 \u2013 Arbitration [see NOTE in COMMERCIAL section] \nEmergency Medical Treatment \nCPLR Article 78 \u2013 Proceeding against a Body or Officer \nHabeas Corpus \nElection Law \nLocal Court Appeal \nExtreme Risk Protection Order \nMechanic\u2019s Lien \nMHL Article 9.60 \u2013 Kendra\u2019s Law \nName Change/Sex Designation Change \nMHL Article 10 \u2013 Sex Offender Confinement (specify):  \nInitial    \nReview \nPistol Permit Revocation Hearing \nMHL Article 81 (Guardianship) \nSale or Finance of Religious/Not-for-Profit Property \nOther Mental Hygiene (specify): ____________________________________________ \nOther (specify): ______________________________________________________ \nOther Special Proceeding (specify): _________________________________________ \nSTATUS OF ACTION OR PROCEEDING \nAnswer YES or NO for every question and enter additional information where indicated. \nYES \nNO \nHas a summons and complaint or summons with notice been filed? \nIf yes, date filed: \n___________________ \nHas a summons and complaint or summons with notice been served? \nIf yes, date served: \n___________________ \nIs this action/proceeding being filed post-judgment? \nIf yes, judgment date: ___________________ \nNATURE OF JUDICIAL INTERVENTION \nCheck one box only and enter additional information where indicated. \nInfant\u2019s Compromise \nExtreme Risk Protection Order Application \nNote of Issue/Certificate of Readiness \nNotice of Medical, Dental or Podiatric Malpractice \nDate Issue Joined: ___________________ \nNotice of Motion \nRelief Requested: ______________________________ \nReturn Date: ___________________ \nNotice of Petition \nRelief Requested: ______________________________ \nReturn Date: ___________________ \nOrder to Show Cause \nRelief Requested: ______________________________ \nReturn Date: ___________________ \nOther Ex Parte Application \nRelief Requested: ______________________________ \nPartition Settlement Conference \nRequest for Preliminary Conference \nResidential Mortgage Foreclosure Settlement Conference \nWaiver of Court Costs, Fees, and Expenses \nWrit of Habeas Corpus \nOther (specify): ____________________________________________________________________________ \nSUPREME\nNEW YORK\n161704\n09/17/2026\nJANE DOE,\nCORNELL UNIVERSITY, INC., CHI PHI CHAPTER HOUSE ASSOCIATION, CHI PHI \nFRATERNITY, INC., CHI PHI EDUCATIONAL TRUST, ALPHA BETA HOUSE \nCORPORATION OF DELTA DELTA DELTA, DELTA DELTA DELTA SORORITY, \nZAREEN \nSexual Assault\n09/16/2026\nName Change\n10/23/2026\nFILED: NEW YORK COUNTY CLERK 09/30/2026 01:25 PM\nINDEX NO. 161704/2026\nNYSCEF DOC. NO. 22\nRECEIVED NYSCEF: 09/30/2026\n1 of 3\n\n--- Page 2 ---\nO\nO\nQ\n@\n@\n@\nRELATED CASES \nList any related actions.  For Matrimonial cases, list any related criminal or Family Court cases.  If none, leave blank. \nIf additional space is required, complete and attach the RJI ADDENDUM (UCS-840A). \nCase Title \nIndex/Case Number \nCourt \nJudge (if assigned) \nRelationship to instant case \nPARTIES \nFor parties without an attorney, check the \u201cUn-Rep\u201d box and enter the party\u2019s address, phone number and email in the space provided. \nIf additional space is required, complete and attach the RJI ADDENDUM (UCS-840A). \nUn-\nRep \nParties \nList parties in same order as listed in the \ncaption and indicate roles (e.g., plaintiff, \ndefendant, 3rd party plaintiff, etc.) \nAttorneys and Unrepresented Litigants \nFor represented parties, provide attorney\u2019s name, firm name, address, phone and \nemail.  For unrepresented parties, provide party\u2019s address, phone and email. \nIssue Joined \nFor each defendant, \nindicate if issue has \nbeen joined. \nInsurance Carriers \nFor each defendant, \nindicate insurance \ncarrier, if applicable. \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nName: \nRole(s): \n YES \n NO \nI AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, \nEXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. \nDated: ___________________ \n_______________________________________________________ \nSignature \n________________________________________________________ \n_______________________________________________________ \nAttorney Registration Number \nPrint Name \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nJane Doe\nPlaintiff\nETHAN COHEN, RHEINGOLD GIUFFRA RUFFO \nPLOTKIN &\nHELLMAN LLP 551 5TH AVE FL 29\nNEW\n \nCornell University, Inc.\nDefendant\n373 Pine Tree Road, Ithaca, NY  14850\n \nChi Phi Chapter HouseAss\nDefendant\nP.O. Box 1600, Ithaca, NY  14850\n \nChi Phi Fraternity, Inc.\nDefendant\n573 Main St.\nGeneva, NY 14456\n \nChi Phi Educational Trust\nDefendant\n885 Woodstock Rd., Ste. 430-389\nRoswell, GA 30075\n \nAlpha Beta House Corpo\nDefendant\n410 E UPLAND, ITHACA, NY14850\n \nDelta Delta Delta Sorority\nDefendant\n14951 Dallas Pkwy., Ste. 500\nDallas, TX 75254\n \nZareen Enterprise LLC d/\nDefendant\n409 EDDY ST., ITHACA, NY, 14850\n \nMatthew Ingalls\nDefendant\n48 TRILLIUM RD, FAIRFIELD, CT 06824\n \nJohnathan Newell\nDefendant\n12944 Stonebrook Dr.\nDavie, FL 33330\n \nWinston Lee\nDefendant\nCornell University- Martin Y. Tang Welcome \nCenter\n616 Th\nt\nA\nIth\nNY 14853\n \nGillio Lopes\nDefendant\n4402 Saul Rd.\nKensington, MD 20895\n \nDiego Sarabia\nDefendant\n7 Short Dr.\nBethel, CT 06801\n \nScott Norris\nDefendant\n5540 Wells Curtice Rd.\nCanandaigua, NY 14424\n \nScott Ketzschmar\nDefendant\n8814 Meisner Rd.\nCasco, MI 48064\n \n09/30/2026\n6213144\nETHAN J COHEN\nFILED: NEW YORK COUNTY CLERK 09/30/2026 01:25 PM\nINDEX NO. 161704/2026\nNYSCEF DOC. NO. 22\nRECEIVED NYSCEF: 09/30/2026\n2 of 3\n\n--- Page 3 ---\nRequest for Judicial Intervention Addendum\nIndex No: ________________________\nCOUNTY OF__________________________\n_______________________COURT,\nFor use when additional space is needed to provide party or related case information.\nFor parties without an attorney, check \"Un-Rep\" box AND enter party address, phone number and e-mail address in \"Attorneys\" space.\nPARTIES:\nInsurance Carrier(s):\n(Y/N):\nJoined\nIssue\nAttorneys and/or Unrepresented Litigants:\nParties: \nRep\nUn-\nlitigants, provide address, phone number and e-mail address.\naddress of all attorneys that have appeared in the case.  For unrepresented\nProvide attorney name, firm name, business address, phone number and e-mail\n3rd-party plaintiff).\nindicate party role(s) (e.g. defendant;\nList parties in caption order and\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nG YES\nFirst Name\nLast Name\nLast Name\nG\nFirm Name\nFirst Name\nG NO\nCity\nStreet Address\nPrimary Role:\ne-mail\nFax\nPhone\nSecondary Role (if any):\nList any related actions.  For Matrimonial actions, include any related criminal and/or Family Court cases.\nRELATED CASES:\nRelationship to Instant Case\nJudge (if assigned)\nCourt\nIndex/Case No.\nCase Title\nUCS-840A (7/2012)\nZip\nState\nZip\nState\nZip\nState\nZip\nState\nZip\nState\nZip\nState\nSupreme\nNew York\n161704/2026\nDoe\nJohn\nDefendant\n \nDoe\nJohn\nDefendant\n \nDoe\nJohn\nDefendant\n \nPetito\nOrazio\nDefendant\nPetito\nOrazio\n107 Jessup Rd\nIthaca\nNew York\n14850\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nPrint Form\nFILED: NEW YORK COUNTY CLERK 09/30/2026 01:25 PM\nINDEX NO. 161704/2026\nNYSCEF DOC. NO. 22\nRECEIVED NYSCEF: 09/30/2026\n3 of 3","thumbnailUrl":"https://lucycraig.blog/media/572/thumb.webp","transcriptStatus":"not_applicable","transcriptText":"","url":"https://lucycraig.blog/media/572"}