Civil Cover Sheet Form. This is a California form and can be use in USDC Central Federal.
Tags: Civil Cover Sheet, CV-71, California Federal, USDC Central
UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET I (a) PLAINTIFFS (Check box if you are representing yourself G) DEFENDANTS (b) Attorneys (Firm Name, Address and Telephone Number. If you are representing yourself, provide same.) Attorneys (If Known) II. BASIS OF JURISDICTION (Place an X in one box only.) G 1 U.S. Government Plaintiff G 2 U.S. Government Defendant III. CITIZENSHIP OF PRINCIPAL PARTIES - For Diversity Cases Only (Place an X in one box for plaintiff and one for defendant.) G 3 Federal Question (U.S. Government Not a Party) PTF DEF G 1 G 1 Incorporated or Principal Place of Business in this State Citizen of This State G 4 Diversity (Indicate Citizenship Citizen of Another State of Parties in Item III) PTF DEF G4 G4 G2 G2 Incorporated and Principal Place G 5 of Business in Another State G5 Citizen or Subject of a Foreign Country G 3 G3 Foreign Nation G6 G6 IV. ORIGIN (Place an X in one box only.) G 1 Original Proceeding G 2 Removed from G 3 Remanded from State Court Appellate Court V. REQUESTED IN COMPLAINT: G 4 Reinstated or Reopened G 5 Transferred from another district (specify): G 6 MultiG 7 Appeal to District District Judge from Litigation Magistrate Judge JURY DEMAND: G Yes G No (Check ‘Yes’ only if demanded in complaint.) CLASS ACTION under F.R.C.P. 23: G Yes G No G MONEY DEMANDED IN COMPLAINT: $ VI. CAUSE OF ACTION (Cite the U.S. Civil Statute under which you are filing and write a brief statement of cause. Do not cite jurisdictional statutes unless diversity.) VII. NATURE OF SUIT (Place an X in one box only.) OTHER STATUTES G 400 State Reapportionment G 410 Antitrust G 430 Banks and Banking G 450 Commerce/ICC Rates/etc. G 460 Deportation G 470 Racketeer Influenced and Corrupt Organizations G 480 Consumer Credit G 490 Cable/Sat TV G 810 Selective Service G 850 Securities/Commodities/ Exchange G 875 Customer Challenge 12 USC 3410 G 890 Other Statutory Actions G 891 Agricultural Act G 892 Economic Stabilization Act G 893 Environmental Matters G 894 Energy Allocation Act G 895 Freedom of Info. Act G 900 Appeal of Fee Determination Under Equal Access to Justice G 950 Constitutionality of State Statutes FOR OFFICE USE ONLY: CONTRACT Insurance Marine Miller Act Negotiable Instrument Recovery of Overpayment & Enforcement of Judgment G 151 Medicare Act G 152 Recovery of Defaulted Student Loan (Excl. Veterans) G 153 Recovery of Overpayment of Veteran’s Benefits G 160 Stockholders’ Suits G 190 Other Contract G 195 Contract Product Liability G 196 Franchise REAL PROPERTY G 210 Land Condemnation G 220 Foreclosure G 230 Rent Lease & Ejectment G 240 Torts to Land G 245 Tort Product Liability G 290 All Other Real Property G 110 G 120 G 130 G 140 G 150 TORTS PERSONAL INJURY G 310 Airplane G 315 Airplane Product Liability G 320 Assault, Libel & Slander G 330 Fed. Employers’ Liability G 340 Marine G 345 Marine Product Liability G 350 Motor Vehicle G 355 Motor Vehicle Product Liability G 360 Other Personal Injury G 362 Personal InjuryMed Malpractice G 365 Personal InjuryProduct Liability G 368 Asbestos Personal Injury Product Liability IMMIGRATION G 462 Naturalization Application G 463 Habeas CorpusAlien Detainee G 465 Other Immigration Actions TORTS PERSONAL PROPERTY G 370 Other Fraud G 371 Truth in Lending G 380 Other Personal Property Damage G 385 Property Damage Product Liability BANKRUPTCY G 422 Appeal 28 USC 158 G 423 Withdrawal 28 USC 157 CIVIL RIGHTS G 441 Voting G 442 Employment G 443 Housing/Accommodations G 444 Welfare G 445 American with Disabilities Employment G 446 American with Disabilities Other G 440 Other Civil Rights PRISONER PETITIONS G 510 Motions to Vacate Sentence Habeas Corpus G 530 General G 535 Death Penalty G 540 Mandamus/ Other G 550 Civil Rights G 555 Prison Condition FORFEITURE / PENALTY G 610 Agriculture G 620 Other Food & Drug G 625 Drug Related Seizure of Property 21 USC 881 G 630 Liquor Laws G 640 R.R. & Truck G 650 Airline Regs G 660 Occupational Safety /Health G 690 Other LABOR G 710 Fair Labor Standards Act G 720 Labor/Mgmt. Relations G 730 Labor/Mgmt. Reporting & Disclosure Act G 740 Railway Labor Act G 790 Other Labor Litigation G 791 Empl. Ret. Inc. Security Act PROPERTY RIGHTS G 820 Copyrights G 830 Patent G 840 Trademark SOCIAL SECURITY G 861 HIA (1395ff) G 862 Black Lung (923) G 863 DIWC/DIWW (405(g)) G 864 SSID Title XVI G 865 RSI (405(g)) FEDERAL TAX SUITS G 870 Taxes (U.S. Plaintiff or Defendant) G 871 IRS-Third Party 26 USC 7609 . Case Number: AFTER COMPLETING THE FRONT SIDE OF FORM CV-71, COMPLETE THE INFORMATION REQUESTED BELOW. CV-71 (05/08) CIVIL COVER SHEET Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET VIII(a). IDENTICAL CASES: Has this action been previously filed in this court and dismissed, remanded or closed? G No G Yes If yes, list case number(s): VIII(b). RELATED CASES: Have any cases been previously filed in this court that are related to the present case? G No If yes, list case number(s): G Yes Civil cases are deemed related if a previously filed case and the present case: (Check all boxes that apply) G A. Arise from the same or closely related transactions, happenings, or events; or G B. Call for determination of the same or substantially related or similar questions of law and fact; or G C. For other reasons would entail substantial duplication of labor if heard by different judges; or G D. Involve the same patent, trademark or copyright, and one of the factors identified above in a, b or c also is present. IX. VENUE: (When completing the following information, use an additional sheet if necessary.) (a) List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH named plaintiff resides. G Check here if the government, its agencies or employees is a named plaintiff. If this box is checked, go to item (b). County in this District:* California County outside of this District; State, if other than California; or Foreign Country (b) List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH named defendant resides. G Check here if the government, its agencies or employees is a named defendant. If this box is checked, go to item (c). County in this District:* California County outside of this District; State, if other than California; or Foreign Country (c) List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH claim arose. Note: In land condemnation cases, use the location of the tract of land involved. County in this District:* California County outside of this District; State, if other than California; or Foreign Country * Los Angeles, Orange, San Bernardino, Riverside, Ventura, Santa Barbara, or San Luis Obispo Counties Note: In land condemnation cases, use the location of the tract of land involved . Date X. SIGNATURE OF ATTORNEY (OR PRO PER): Notice to Counsel/Parties: The CV-71 (JS-44) Civil Cover Sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law. This form, approved by the Judicial Conference of the United States in September 1974, is required pursuant to Local Rule 3-1 is not filed but is used by the Clerk of the Court for the purpose of statistics, venue and initiating the civil docket sheet. (For more detailed instructions, see separate instructions sheet.) Key to Statistical codes relating to Social Security Cases: Nature of Suit Code Abbreviation Substantive Statement of Cause of Action 861 HIA All claims for health insurance benefits (Medicare) under Title 18, Part A, of the Social Security Act, as amended. Also, include claims by hospitals, skilled nursing facilities, etc., for certification as providers of services under the program. (42 U.S.C. 1935FF(b)) 862 BL All claims for “Black Lung” benefits under Title 4, Part B, of the Federal Coal Mine Health and Safety Act of 1969. (30 U.S.C. 923) 863 DIWC All claims filed by insured workers for disability insurance benefits under Title 2 of the Social Security Act, as amended; plus all claims filed for child’s insurance benefits based on disability. (42 U.S.C. 405(g)) 863 DIWW All claims filed for widows or widowers insurance benefits based on disability under Title 2 of the Social Security Act, as amended. (42 U.S.C. 405(g)) 864 SSID All claims for supplemental security income payments based upon disability filed under Title 16 of the Social Security Act, as amended. 865 RSI All claims for retirement (old age) and survivors benefits under Title 2 of the Social Security Act, as amended. (42 U.S.C. (g)) CV-71 (05/08) CIVIL COVER SHEET Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com