IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA. IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY, FLORIDA. DIVISION CIVIL DISTRICTS FAMILY OTHER PLAINTIFF CASE NUMBER CIVIL COVER SHEET VS. DEFENDANT CLOCK IN The civil cover sheet and the information contained here does not replace the filing and service of pleadings or other papers as required by law. This form is required by the Clerk of Court for the purpose of reporting judicial workload data pursuant to Florida Statute 25.075. See instructions and definitions on reverse of this form. 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), place an x in both the main category and subcategory boxes. 001 - Eminent Domain 003 - Contracts and Indebtedness 010 - Auto Negligence 022 - Products Liability 023 - Condominium Negligence - Other 097 - Business Governance 098 - Business Torts 099 - Environmental/Toxin Tort 100 - Third Party Indemnification 101 - Construction Defect 102 - Mass Tort 103 - Negligent Security 104 - Nursing Home Negligence 105 - Premises Liability - Commercial 106 - Premises Liability - Residential 107 - Negligence - Other Real Property/Mortgage Foreclosure 108 - Commercial Foreclosure $0 - $50,000 109 - Commercial Foreclosure $50,001 - $249,999 110 - Commercial Foreclosure $250,000 - or more 111 - Homestead Residential Foreclosure $0 - $50,000 112 - Homestead Residential Foreclosure $50,001 - $249,999 113 - Homestead Residential Foreclosure $250,000 or more 114 - Non-Homestead Residential Foreclosure $0 - $50,000 115 - Non-Homestead Residential Foreclosure $50,001 - $249,999 116 - Non-Homestead Residential Foreclosure $250,000 or more 117 - Other Real Property Actions $0 - $50,000 118 - Other Real Property Actions $50,001 $249,999 119 - Other Real Property Actions $250,000 or more Professional Malpractice 094 - Malpractice - Business 095 - Malpractice - Medical 096 - Malpractice - Other professional Other 120 - Antitrust/Trade Regulation 121 - Business Transactions 122 - Constitutional Challenge - Statute or Ordinance 123 - Constitutional Challenge - Proposed amendment 124 - Corporate Trust 125 - Discrimination - Employment or Other 126 - Insurance Claims 127 - Intellectual Property 128 - Libel/Slander 129 - Shareholder Derivative Action 130 - Securities Litigation 131 - Trade Secrets 132 - Trust Litigation 133 - Other Civil Complaint 009 - Bond Estreature 014 - Replevin 024 - Witness Protection 080 - Declaratory Judgment 081 - Injunctive Relief 082 - Equitable Relief 083 - Construction Lien 084 - Petition for Adversary Preliminary Hearing 085 - Civil Forfeiture 086 - Voluntary Binding Arbitration 087 - Personal Injury Protection (PIP) CLK/CT 96 Rev. 12/09 Clerk's web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com COMPLEX BUSINESS COURT This action is appropriate for assignment to Complex Business Court as delineated and mandated by the Administrative Order. Yes No REMEDIES SOUGHT (check all that apply): monetary; non-monetary declaratory or injunctive relief; punitive NUMBER OF CAUSES OF ACTION: [ ] (specify) _________________________________________________________________________________ ________________________________________________________________________________________ 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 my knowledge and belief. Signature __________________________________________ Florida Bar # __________________________ Attorney or party (Bar # if attorney) _________________________________________________ (type or print name) ____________________________ Date CLK/CT 96 Rev. 12/09 Clerk's web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET Plaintiff must file this cover sheet with first paperwork filed in the action or proceeding (except small claims cases or other county court cases, probate, or family cases). Domestic and juvenile cases should be accompanied by a completed Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases. Failure to file a civil cover sheet in any civil case other than those excepted above may result in sanctions. I. Case Style. Enter the name of the court, the appropriate case number assigned at the time of filing of the original complaint or petition, the name of the judge assigned (if applicable), and the name (last, first, middle initial) of plaintiff(s) and defendant(s). II. Type of Case. Place an "X" in the appropriate box. If the cause fits more than one type of case, select the most definitive. If the most definitive label is a subcategory (indented under a broader category label, place an "X" in the category and subcategory boxes. Definitions of the cases are provided below in the order they appear on the form. (A) Condominium - all civil lawsuits pursuant to Chapter 718, Florida Statutes, in which a condominium association is a party. (B) Contracts and indebtedness - all contract actions relating to promissory notes and other debts, including those arising from sale of goods, but excluding contract disputes involving condominium associations. (C) Eminent domain - all matters relating to the taking of private property for public use, including inverse condemnation by state agencies, political subdivisions, or public service corporations. (D) Auto negligence - all matter arising out of a party's allegedly negligent operation of a motor vehicle. (E) Negligence-other - all actions sounding in negligence, including statutory claims for relief on account of death or injury, that are not included in other main categories. (F) Business governance - all matters relating to the management, administration, or control of a company. (G) Business torts - all matters relating to liability for economic loss allegedly caused by interfere