UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET I. (a) PLAINTIFFS ( Check box if you are representing yourself ) DEFENDANTS ( Check box if you are representing yourself ) (b) County of Residence of First Listed Plaintiff (EXCEPT IN U.S. PLAINTIFF CASES) County of Residence of First Listed Defendant (IN U.S. PLAINTIFF CASES ONLY) (c) Attorneys (Firm Name, Address and Telephone Number) If you are representing yourself, provide the same information. Attorneys (Firm Name, Address and Telephone Number) If you are representing yourself, provide the same information. II. BASIS OF JURISDICTION (Place an X in one box only.) 1. U.S. Government Plaintiff 2. U.S. Government Defendant 1. Original Proceeding III. CITIZENSHIP OF PRINCIPAL PARTIES-For Diversity Cases Only (Place an X in one box for plaintiff and one for defendant) PTF 1 2 3 DEF 1 2 Citizen of This State Citizen of Another State Citizen or Subject of a Foreign Country Incorporated or Principal Place of Business in this State Incorporated and Principal Place of Business in Another State PTF 4 5 6 DEF 4 5 6 3. Federal Question (U.S. Government Not a Party) 4. Diversity (Indicate Citizenship of Parties in Item III) 3. Remanded from Appellate Court 3 Foreign Nation IV. ORIGIN (Place an X in one box only.) 2. Removed from State Court 4. Reinstated or Reopened 5. Transferred from Another District (Specify) 6. Multidistrict Litigation Transfer 8. Multidistrict Litigation Direct File V. REQUESTED IN COMPLAINT: JURY DEMAND: CLASS ACTION under F.R.Cv.P. 23: Yes No Yes No (Check "Yes" only if demanded in complaint.) MONEY DEMANDED IN COMPLAINT: $ Do not cite jurisdictional statutes unless diversity.) VI. CAUSE OF ACTION (Cite the U.S. Civil Statute under which you are filing and write a brief statement of cause. VII. NATURE OF SUIT (Place an X in one box only). OTHER STATUTES 375 False Claims Act 376 Qui Tam (31 USC 3729(a)) 400 State Reapportionment 410 Antitrust 430 Banks and Banking 450 Commerce/ICC Rates/Etc. 460 Deportation 470 Racketeer Influenced & Corrupt Org. 480 Consumer Credit 490 Cable/Sat TV 850 Securities/Commodities/Exchange 890 Other Statutory Actions 891 Agricultural Acts 893 Environmental Matters 895 Freedom of Info. Act 896 Arbitration 899 Admin. Procedures Act/Review of Appeal of Agency Decision 950 Constitutionality of State Statutes FOR OFFICE USE ONLY: CV-71 (07/16) CONTRACT 110 Insurance 120 Marine 130 Miller Act 140 Negotiable Instrument 150 Recovery of Overpayment & Enforcement of Judgment 151 Medicare Act 152 Recovery of Defaulted Student Loan (Excl. Vet.) 153 Recovery of Overpayment of Vet. Benefits 160 Stockholders' Suits 190 Other Contract 195 Contract Product Liability 196 Franchise REAL PROPERTY 210 Land Condemnation 220 Foreclosure 230 Rent Lease & Ejectment Case Number: CIVIL COVER SHEET REAL PROPERTY CONT. 240 Torts to Land 245 Tort Product Liability 290 All Other Real Property TORTS PERSONAL INJURY 310 Airplane 315 Airplane Product Liability 320 Assault, Libel & Slander 330 Fed. Employers' Liability 340 Marine 345 Marine Product Liability 350 Motor Vehicle 355 Motor Vehicle Product Liability 360 Other Personal Injury 362 Personal InjuryMed Malpratice 365 Personal InjuryProduct Liability 367 Health Care/ Pharmaceutical Personal Injury Product Liability 368 Asbestos Personal Injury Product Liability IMMIGRATION 462 Naturalization Application 465 Other Immigration Actions TORTS PERSONAL PROPERTY 370 Other Fraud 371 Truth in Lending 380 Other Personal Property Damage 385 Property Damage Product Liability BANKRUPTCY 422 Appeal 28 USC 158 423 Withdrawal 28 USC 157 CIVIL RIGHTS 440 Other Civil Rights 441 Voting 442 Employment 443 Housing/ Accommodations 445 American with DisabilitiesEmployment 446 American with Disabilities-Other 448 Education PRISONER PETITIONS Habeas Corpus: 463 Alien Detainee 510 Motions to Vacate Sentence 530 General 535 Death Penalty Other: 540 Mandamus/Other 550 Civil Rights 555 Prison Condition 560 Civil Detainee Conditions of Confinement FORFEITURE/PENALTY 625 Drug Related Seizure of Property 21 USC 881 690 Other LABOR 710 Fair Labor Standards Act 720 Labor/Mgmt. Relations 740 Railway Labor Act 751 Family and Medical Leave Act 790 Other Labor Litigation 791 Employee Ret. Inc. Security Act PROPERTY RIGHTS 820 Copyrights 830 Patent 840 Trademark SOCIAL SECURITY 861 HIA (1395ff) 862 Black Lung (923) 863 DIWC/DIWW (405 (g)) 864 SSID Title XVI 865 RSI (405 (g)) FEDERAL TAX SUITS 870 Taxes (U.S. Plaintiff or Defendant) 871 IRS-Third Party 26 USC 7609 American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 3 UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET VIII. VENUE: Your answers to the questions below will determine the division of the Court to which this case will be initially assigned. This initial assignment is subject to change, in accordance with the Court's General Orders, upon review by the Court of your Complaint or Notice of Removal. QUESTION A: Was this case removed from state court? Yes No If "no, " skip to Question B. If "yes," check the box to the right that applies, enter the corresponding division in response to Question E, below, and continue from there. STATE CASE WAS PENDING IN THE COUNTY OF: Los Angeles, Ventura, Santa Barbara, or San Luis Obispo Orange Riverside or San Bernardino INITIAL DIVISION IN CACD IS: Western Southern Eastern QUESTION B: Is the United States, or B.1. Do 50% or more of the defendants who reside in the district reside in Orange Co.? one of its agencies or employees, a PLAINTIFF in this action? check one of the boxes to the right Yes No B.2. Do 50% or more of the defendants who reside in the district reside in Riverside and/or San Bernardino Counties? (Consider the two counties together.) check one of the boxes to the right YES. Your case will initially be assigned to the Southern Division. Enter "Southern" in response to Question E, below, and continue from there. NO. Continue to Question B.2. YES. Your case will initially be assigned to the Eastern Division. Enter "Eastern" in response to Question E, below, and continue from there. NO. Your case will initially be assigned to the Western Division. Enter "Western" in response to Question E, below, and continue from there. YES. Your case will initially be assigned to the Southern Division. Enter "Southern" in response to Question E, below, and continue from there. NO. Continue to Question C.2. If "no, " skip to Question C. If "yes," answer