O JS 44 (R ev. 2/08) CIVIL COVER SHEET The 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, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. (SEE IN STR U C TIO N S O N THE R EV ER SE O F T HE FO R M .) NOTICE: Attorneys MUST Indicate All Re-filed Cases Below. I. (a) PLAINTIFFS DEFENDANTS (b) County of Residence of First Listed Plaintiff County of Residence of First Listed Defendant (EX C EPT IN U .S. PLAIN TIFF C ASES) (IN U .S. PLAIN TIFF C ASES O N LY ) (c) Attorney’s (Firm N ame, Address, and Telephone N umber) N O TE: IN LAN D C O N D EM N ATIO N C ASES, U SE THE LO C ATIO N O F THE TR AC T LAN D IN V O LV ED . Attorneys (If Know n) (d) ’ M IAM I- D AD E Check County Where Action Arose: II. BASIS OF JURISDICTION ’ MONROE ’ BR O W AR D ’ PALM BEA CH ’ M AR TIN ’ ST. LU C IE U .S. G overnment Plaintiff ’ 3 U .S. G overnment D efendant ’ 4 ’ O KEEC HO BEE HIG HLAN D S III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X ” in O ne Box for Plaintiff (Place an “ X ” in O ne Box O nly) (For D iversity C ases O nly) ’ 1 ’ IN D IAN R IV ER and O ne Box for D efendant) PTF DEF Incorporated or Principal Place ’ 4 ’ 4 of Business In This State C itizen of This State ’ D iversity C itizen of Another State ’ 2 ’ 2 Incorporated and Principal Place of Business In A nother State ’ 5 ’ 5 C itizen or Subject of a Foreign C ountry ’ 2 Federal Q uestion (U .S. G overnment N ot a Party) ’ 3 ’ 3 Foreign N ation ’ 6 ’ 6 (Place an “X ” in O ne B ox O nly) CONTRACT ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ TORTS 110 Insurance 120 M arine 130 M iller Act 140 N egotiable Instrument 150 R ecovery of O verpayment & Enforcement of Judgment 151 M edicare Act 152 R ecovery of D efaulted Student Loans (Excl. V eterans) 153 R ecovery of O verpayment of V eteran’s Benefits 160 Stockholders’ Suits 190 O ther C ontract 195 C ontract Product Liability 196 Franchise R E A L P R O PE R T Y 210 Land C ondemnation 220 Foreclosure 230 R ent Lease & Ejectment 240 Torts to Land 245 Tort Product Liability ’ 290 All O ther R eal Property ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ Proceeding F O R FE IT U R E /P E N A L T Y P E R SO N A L IN JU R Y P E R SO N A L IN JU R Y 310 Airplane ’ 362 Personal Injury 315 Airplane Product M ed. M alpractice Liability ’ 365 Personal Injury 320 Assault, Libel & Product Liability Slander ’ 368 Asbestos Personal 330 Federal Employers’ Injury P roduct Liability Liability 340 M arine P E R SO N A L P R O P E R T Y 345 M arine Product ’ 370 O ther Fraud Liability ’ 371 Truth in Lending 350 M otor V ehicle ’ 380 O ther Personal 355 M otor V ehicle Property D amage Product Liability ’ 385 Property D amage 360 O ther Personal Product Liability Injury C IV IL R IG H T S P R ISO N E R P E T IT IO N S 441 V oting ’ 510 M otions to V acate 442 Employment Sentence 443 Housing/ H abeas C orpus: Accommodations ’ 530 G eneral 444 W elfare ’ 535 D eath Penalty 445 Amer. w /D isabilities ’ 540 M andamus & O ther Employment 446 Amer. w /D isabilities ’ 550 C ivil R ights O ther ’ 440 O ther C ivil R ights V. ORIGIN ’ 1 Original DEF ’ 1 (Indicate C itizenship of Parties in Item III) IV. NATURE OF SUIT ’ ’ ’ ’ ’ PTF 1 ’ 555 Prison C ondition ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ 610 Agriculture 620 O ther Food & D rug 625 D rug R elated Seizure of Property 21 U SC 881 630 Liquor Law s 640 R .R . & Truck 650 Airline R egs. 660 O ccupational Safety/Health 690 O ther LABOR 710 Fair Labor Standards Act 720 Labor/M gmt. R elations 730 Labor/M gmt.R eporting & D isclosure Act 740 R ailw ay Labor Act 790 O ther Labor Litigation 791 E m pl. R et. Inc . Security Act State Court VI. RELATED/RE-FILED CASE(S). ’ 3 Re-filed- (see VI below) ’ SO C IA L SE C U R IT Y 861 HIA (1395ff) 862 Black Lung (923) 863 D IW C /D IW W (405(g)) 864 SSID Title X V I 865 R SI (405(g)) F E D E R A L T A X SU IT S ’ 870 Taxes (U .S. Plaintiff or D efendant) ’ 871 IR S— Third Party 26 U SC 7609 ’ ’ ’ ’ ’ (specify) ’ ’ ’ 400 State R eapportionment 410 Antitrust 430 Banks and Banking 450 C ommerce 460 D eportation 470 R acketeer Influenced and C orrupt O rganizations 480 C onsumer C redit 490 Cable/Sat TV 810 Selective Service ’ 850 Securities/C ommodities/ Exchange ’ ’ ’ ’ ’ ’ ’ ’ Transferred from Reopened O T H E R ST A T U T E S ’ ’ ’ ’ ’ ’ 875 C ustomer C hallenge 12 U SC 3410 890 O ther Statutory Actions 891 Agricultural Acts 892 Economic Stabilization Act 893 Environmental M atters 894 Energy Allocation Act 895 Freedom of Information Act ’ 900 Appeal of Fee D etermination U nder Equal Access to Justice 4 Reinstated or ’ 5 another district a) Re-filed Case ’ YES ’ NO (See instructions second page): P R O PE R T Y R IG H T S ’ 820 C opyrights ’ 830 Patent ’ 840 Trademark IM M IG R A T IO N 462 N aturalization Application 463 Habeas C orpus-Alien D etainee 465 O ther Immigration Actions (Place an “X ” in O ne B ox O nly) ’ 2 Removed from B A N K R U PT C Y ’ 422 Appeal 28 U SC 158 ’ 423 W ithdraw al 28 U SC 157 950 C onstitutionality of State Statutes Appeal to District ’ 6 Multidistrict Litigation ’ 7 Judge from Magistrate Judgment b) Related Cases ’ YES ’ NO JUDGE DOCKET NUMBER 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. CAUSE OF ACTION LENGTH OF TRIAL via ______ days estimated (for both sides to try entire case) VIII. REQUESTED IN COM PLAINT: ’ CHECK IF THIS IS A CLASS ACTION DEMAND $ UNDER F.R.C.P. 23 ABOVE INFORMATION IS TRUE & CORRECT TO THE BEST OF MY KNOWLEDGE SIG N ATU R E O F ATTO R N EY O F R EC O R D CHECK YES only if demanded in complaint: ’ Yes ’ No JURY DEMAND: D ATE F O R O F F IC E U SE O N L Y AM O U N T R EC EIPT # IFP American LegalNet, Inc. www.FormsWorkflow.com JS 44 R everse (R ev. 02/08) INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44 Authority For Civil Cover Sheet The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint filed. The attorney filing a case should complete the form as follows: I. (a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both name and title. (b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the “defendant” is the location of the tract of land involved.) (c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting in this section “(see attachment)”. (d) Choose one County where Action Arose. II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires that jurisdictions be shown in pleadings. Place an “X” in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below. United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here. United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an “X” in this box. Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be marked. Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the different parties must be checked. (See Section III below; federal question actions take precedence over diversity cases.) III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this section for each principal party. IV. Nature of Suit. Place an “X” in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is sufficient to enable the deputy clerk or the statistical clerks in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the most definitive. V. Origin. Place an “X” in one of the seven boxes. Original Proceedings. (1) Cases which originate in the United States District Courts. Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition for removal is granted, check this box. Refiled (3) Attach copy of Order for Dismissal of Previous case. Also complete VI. Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date. Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict litigation transfers. Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box is checked, do not check (5) above. Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judge’s decision. VI. Related/Refiled Cases. This section of the JS 44 is used to reference related pending cases or re-filed cases. Insert the docket numbers and the corresponding judges name for such cases. VII. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes unless diversity. Example: U.S. Civil Statute: 47 USC 553 Brief Description: Unauthorized reception of cable service VIII. Requested in Complaint. Class Action. Place an “X” in this box if you are filing a class action under Rule 23, F.R.Cv.P. Demand. In this space enter the dollar amount (in thousands of dollars) being demanded or indicate other demand such as a preliminary injunction. Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded. Date and Attorney Signature. Date and sign the civil cover sheet. 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