`NYSCEF DOC. NO. 2
`
`INDEX NO. 814633/2023
`
`RECEIVED NYSCEF: 11/14/2023
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF ERIE
`
`TROY SHANE SMITH and ALLYSON JANE
`SMITH,
`
`
`
`v.
`
`84 LUMBER COMPANY, et al.,
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`) Index No.
`
`
`PLAINTIFFS’ STATEMENT
`
`)
`)
`)
`
`) EIGHTH JUDICIAL DISTRICT
`)
`ASBESTOS LITIGATION
`)
`
`)
`
`)
`
`
`Plaintiffs,
`
`Defendants.
`
`
`
`PLEASE STATE:
`
`1.
`
`Nature of Action:
`
`Personal Injury
`
`___X___
`
`
`
`
`
`
`
`Wrongful Death
`
`______
`
`PLEASE STATE AS TO PLAINTIFF:
`
`2.
`
`3.
`
`4.
`
`5.
`
`Full Name: Troy Shane Smith
`
`Address:
`
`2600 Stillwater Court, Flower Mound, TX 75022
`
`Date of Birth: XX/XX/1970
`
`Social Security Number: To be provided
`
`PLEASE STATE FOR PLAINTIFF'S SPOUSE:
`
`6.
`
`7.
`
`8.
`
`9.
`
`Full Name: Allyson Jane Smith
`
`Address:
`
`2600 Stillwater Court, Flower Mound, TX 75022
`
`Date of Birth: XX/XX/1973
`
`Social Security Number: To be provided
`
`PLEASE STATE FOR DECEDENT (WHERE APPROPRIATE):
`
`10.
`
`Full Name:
`
`
`
`11.
`
`Last Address:
`
`12.
`
`Date of Birth:
`
`
`
`
`
`1
`
`
`
`FILED: ERIE COUNTY CLERK 11/14/2023 11:32 AM
`NYSCEF DOC. NO. 2
`
`INDEX NO. 814633/2023
`
`RECEIVED NYSCEF: 11/14/2023
`
`13.
`
`Social Security Number:
`
`14.
`
`Date and Place of Death:
`
`
`
`15.
`
`Cause of Death:
`
`16.
`
`Indicate which of the following types of activity resulted in plaintiff’s/decedent’s alleged
`
`exposure to asbestos:
`
`(a)
`
`Insulating trade
`
`(b)
`
`Boiler trade
`
`(c)
`
`Construction trade
`
`(d)
`
`Plant worker
`
`(e)
`
`Brake lining or friction worker
`
`(f)
`
`Non-occupational (indicate site)
`
`(g)
`
`Railroad
`
`(h)
`
`Other (describe)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`17.
`
`Primary Work Sites: Lawn mowing; construction work; Papa Aldo’s Pizza;
`
`secondhand exposure from father’s work
`
`18.
`
`Date of First Exposure: Approximately 1980s
`
`19.
`
`Date of Last Exposure: Approximately 1987
`
`20.
`
`Asbestos Containing Products To Which Plaintiff/Decedent Was Allegedly Exposed (If
`
`Known): Plaintiff contends he was exposed to a variety of asbestos-containing products
`
`and asbestos containing machinery and equipment at his various worksites through his
`
`own use of these products and product use by his co-workers.
`
`21.
`
`Nature of alleged asbestos related illness: Mesothelioma
`
`Date of diagnosis: On or about July 18, 2023
`
`22.
`
`Has plaintiff or did decedent ever smoke cigarettes?
`
`Yes_____
`
`
`
`No__X__
`
`
`
`
`
`2
`
`
`
`FILED: ERIE COUNTY CLERK 11/14/2023 11:32 AM
`NYSCEF DOC. NO. 2
`
`INDEX NO. 814633/2023
`
`RECEIVED NYSCEF: 11/14/2023
`
`If so, state the number of years and the number of packs per day of plaintiff's/decedent's
`
`smoking: Plaintiff is a lifelong non-smoker
`
`23.
`
`Has plaintiff been or was decedent exposed to non-asbestos containing products or
`
`substances which have demonstrated to cause or contribute to lung disease, injury or
`
`dysfunction? No.
`
`If so, state all such products or substances: N/A.
`
`24.
`
`Prior asbestos actions: None.
`
`Dated: New York, New York
`
`November 14, 2023
`
`
`Yours etc.,
`
`BELLUCK & FOX, LLP
`Attorneys for Plaintiff
`546 Fifth Avenue, 5th Floor
`New York, New York 10036
`(212) 681-1575
`
`By:/s/ Joseph W. Belluck, Esq.
`
`Joseph W. Belluck, Esq.
`
`
`
`
`
`
`
`3
`
`
`
`FILED: ERIE COUNTY CLERK 11/14/2023 11:32 AM
`NYSCEF DOC. NO. 2
`
`INDEX NO. 814633/2023
`
`RECEIVED NYSCEF: 11/14/2023
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF ERIE
`
`TROY SHANE SMITH and ALLYSON JANE
`SMITH,
`
`
`
`v.
`
`84 LUMBER COMPANY, et al.,
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`) Index No.
`
`
`
`)
`)
`)
`)
`)
`)
`)
`)
`
`
`CERTIFICATION
`
`
`
`
`
`
`
`Plaintiffs,
`
`Defendants.
`
`
`
`Joseph W. Belluck, Esq., an attorney duly admitted to practice before the Courts of the State
`
`of New York, hereby certifies in accordance with 22 NYCRR Part 130-1.1-a of the Rules of the
`
`Chief Administrator that to the best of my knowledge, information and belief, which was formed
`
`after a reasonable inquiry under the circumstances, the presentation of the annexed Plaintiff's
`
`Statement and it contents are not frivolous.
`
`Dated: New York, New York
`
`November 14, 2023
`
`
`Yours etc.,
`
`BELLUCK & FOX, LLP
`Attorneys for Plaintiff
`546 Fifth Avenue, 5th Floor
`New York, New York 10036
`(212) 681-1575
`
`By:/s/ Joseph W. Belluck, Esq.
`
`Joseph W. Belluck, Esq.
`
`
`
`
`
`
`
`4
`
`
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