IN THE COUNTY COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA CASE NUMBER: 05 DIVISION: CIVIL PLAINTIFF CLOCK IN -XXXX-XX DEFENDANT CIVIL COVER SHEET TYPE OF CASE If the case fits more than one type of case, select the most definitive category. If the most descriptive label is a subcategory (is indented under a broader category), please an X in both the main category and subcategory boxes. Condominium $50,000 Contracts and indebtedness $249,999 Eminent domain Auto negligence Negligence - other Business governance Business torts Environmental/Toxic tort Third party indemnification Construction defect Mass tort $249,999 Negligent security Nursing home negligence Premises liability - commercial Premises liability - residential Products liability Real property/Mortgage foreclosure Commercial foreclosure $0-$50,000 Commercial foreclosure $50,001-$249,999 Commercial foreclosure $250,000 or more Homestead residential foreclosures $0 - $50,000 Law 122 / Rev. 08-06-2015 1 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL COVER SHEET 05- CASE NUMBER JUDGE -XXXX-XX Homestead residential foreclosures $50,001-$249,999 Homestead residential foreclosures $250,000 or more Non-homestead residential foreclosure $0-$50,000 Non-homestead residential foreclosure $50,000-$249,999 Non-homestead residential foreclosure $249,999 or more Other real property actions $0-$50,000 Other real property actions $50,001-$249,999 Other real property actions $250,000 or more Professional malpractice Malpractice - business Malpractice - medical Malpractice - other professional Other Antitrust/Trade regulation Business transactions Constitutional challenge-statute or ordinance Constitutional challenge-proposed amendment Corporate trusts Discrimination - employment or other Insurance claims Intellectual property Libel/Slander Shareholder derivative action Securities litigation Trade secrets Trust litigation REMEDIES SOUGHT (check all that apply) Monetary Non-monetary declaratory or injunctive relief Punitive NUMBER OF CAUSES OF ACTION [ ] (specify)______________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Law 122 / Rev. 08-06-2015 2 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL COVER SHEET 05- CASE NUMBER -XXXX-XX JUDGE IS THIS CASE A CLASS ACTION LAWSUIT? Yes No HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED? No Yes If "yes", list all related cases by name, case number, and court. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ IS JURY TRIAL DEMANDED IN COMPLAINT? Yes No I CERTIFY that the information I have provided in this cover sheet is accurate to the best of knowledge and belief. Signature: _____________________________ FL Bar No.:_______________________ Attorney or Party (Bar number, if attorney) Type or Print Name:___________________________ Date:_______________________ Law 122 / Rev. 08-06-2015 3 American LegalNet, Inc. www.FormsWorkFlow.com