Civil Cover Sheet (SLR 2.011 rev 022312) Page 1 of 1 CIVIL CASE MANAGEMENT SHEET (see SLR 2.011 for required use) Case no.: PARTIES (list overflow on separate sheets): Pleading has Class Action Allegations: Plaintiffs: Defendants: Related cases in Multnomah County Circuit Court (case number(s)): Has this case been filed previously, or is it related to a case file previously in this court or in another court? No Yes In this Circuit Court Case No. Yes In another Circuit Court Case No. County: Yes In US District Court Case No. Location: PLAINTIFF: I am self - represented Name: OSB Number: Phone Number: Address: (Street) (City) (State) (Zip) Email address: Notice of a change of address pursuant to UTCR 2.010(14). TYPE OF CASE (select ONE Primary Subject selection does not bind or limit legal theories): Tort and Employment Motor vehicle (including (UM & UIM) Intentional personal injury (including assault, battery, false arrest, intentional infliction of emotional distress) Construction Defect Product liability Wrongful Death Employer liability (ELL) Negligence Employment discrimination/ wrongful discharge Professional negligence medical Wage and hour Professional negligence (legal, other) Employment contract Defamation Other (specify): Fraud Intentional injury to property (including nuisance and trespass) Contract (other than employment) Real Property Money Action (consumer credit) Quiet Title Insurance Condemnation/Eminent Domain Negotiable instrument Foreclosure Other (specify): Specific Performance Other Declaratory Judgment/Injunctive Relief Elder Abuse Intellectual property Interpleader (ORCP 31) Derivative Shareholder suit Other (specify): Securities No Yes American LegalNet, Inc. www.FormsWorkFlow.com