CIRCUIT COURT, PINELLAS COUNTY, FLORIDA CIVIL DIVISION CIVIL COVER SHEET The 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 shall be filed by the plaintiff or petitioner for the use of the Clerk of Court for the purpose of reporting judicial workload data pursuant to Florida Statutes section 25.075. (See instructions for completion.) I. CASE STYLE Case #: Plaintiff Judge: vs. Defendant II. 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. Condominium Contracts and indebtedness Eminent domain ͙ Other real property actions $250,000 or more Professional malpractice Malpractice—business Malpractice—medical Malpractice—other professional Auto negligence Other Negligence—other Business governance Business torts Environmental/Toxic tort Third party indemnification Construction defect Mass tort Negligent security Nursing home negligence Premises liability—commercial Premises liability—residential Products liability Real property/Mortgage foreclosure ͙ ͙ ͙ ͙ ͙ ͙ 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 Commercial foreclosure $0 - $50,000 Commercial foreclosure $50,001 - $249,999 Commercial foreclosure $250,000 or more Homestead residential foreclosure $0 - $50,000 Homestead residential foreclosure $50,001 $249,999 Homestead residential foreclosure $250,000 or more Non-homestead residential foreclosure $0 - $50,000 Non-homestead residential foreclosure $50,001 $249,999 Non-homestead residential foreclosure $250,000 or more Other real property actions $0 - $50,000 Other real property actions $50,001 - $249,999 (Form 1.997 Civil Rules of Procedure 1/2010) American LegalNet, Inc. www.FormsWorkFlow.com III. REMEDIES SOUGHT (check all that apply): monetary; nonmonetary declaratory or injunctive relief; punitive IV. NUMBER OF CAUSES OF ACTION: [ (specify) ] V. IS THIS CASE A CLASS ACTION LAWSUIT? yes no VI. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED? no yes If “yes,” list all related cases by name, case number, and court. VII. 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. Fla. Bar # Signature Attorney or party (type or print name) (Form 1.997 Civil Rules of Procedure 1/2010) (Bar # if attorney) Date American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET .FORM 1.997 – Civil Rules of Procedure 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) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M) (N) (O) (P) (Q) (R) (S) Condominium - all civil lawsuits pursuant to Chapter 718, Florida Statutes, in which a condominium association is a party. Contracts and indebtedness - all contract actions relating to promissory notes and other debts, including those arising from the sale of goods, but excluding contract disputes involving condominium associations. 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. Auto negligence - all matters arising out of a party’s allegedly negligent operation of a motor vehicle. 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. Business governance - all matters relating to the management, administration, or control of a company. Business torts - all matters relating to liability for economic loss allegedly caused by interference with economic or business relationships. Environmental/Toxic tort - all matters relating to claims that violations of environmental regulatory provisions or exposure to a chemical caused injury or disease. Third party indemnification - all matters relating to liability transferred to a third party in a financial relationship. Construction defect - all civil lawsuits in which damage or injury was allegedly caused by defects in the construction of a structure. Mass tort - all matters relating to a civil action involving numerous plaintiffs against one or more defendants. Negligent security - all matters involving injury to a person or property allegedly resulting from insufficient security. Nursing home negligence - all matters involving injury to a nursing home resident resulting from negligence of nursing home staff or facilities. Premises liability—commercial - all matters involving injury to a person or property allegedly resulting from a defect on the premises of a commercial property. Premises liability—residential - all matters involving injury to a person or property allegedly resulting from a defect on the premises of a residential property. Products liability - all matters involving injury to a person or property allegedly resulting from the manufacture or sale of a defective product or from a failure to warn. Real property/Mortgage foreclosure - all matters relating to the possession, title, or boundaries of real property. All matters involving foreclosures or sales of real property, including foreclosures associated with condominium associations or condominium units. Commercial foreclosure - all matters relating to the termination of a business owner’s interest in commercial property by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property. Check the category that includes the estimate of the amount in controversy of the claim (section 28.241, Florida Statutes). Homestead residential foreclosure - all matters relating to the termination of a residential property owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property where the property has been granted a homestead exemption. Check the category that includes the estimate of the amount in controversy of the claim (section 28.241, Florida Statutes). (Form 1.997 Civil Rules of Procedure 1/2010) American LegalNet, Inc. www.FormsWorkFlow.com (T) (U) (V) (W) (X) (Y) (Z) (AA) (AB) (AC) (AD) (AE) (AF) (AG) (AH) (AI) (AJ) (AK) (AL) (AM) Non-homestead residential foreclosure - all matters relating to the termination of a residential property owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property where the property has not been granted a homestead exemption. Check the category that includes the estimate of the amount in controversy of the claim (section 28.241, Florida Statutes). Other real property actions - all matters relating to land, land improvements, or property rights not involving commercial or residential foreclosure. Check the category that includes the estimate of the amount in controversy of the claim (section 28.241, Florida Statutes). Professional malpractice - all professional malpractice lawsuits. Malpractice—business - all matters relating to a business’s or business person’s failure to exercise the degree of care and skill that someone in the same line of work would use under similar circumstances. Malpractice—medical - all matters relating to a doctor’s failure to exercise the degree of care and skill that a physician or surgeon of the same medical specialty would use under similar circumstances. Malpractice—other professional - all matters relating to negligence of those other than medical or business professionals. Other - all civil matters not included in other categories. Antitrust/Trade regulation - all matters relating to unfair methods of competition or unfair or deceptive business acts or practices. Business transactions - all matters relating to actions that affect financial or economic interests. Constitutional challenge—statute or ordinance - a challenge to a statute or ordinance, citing a violation of the Florida Constitution. Constitutional challenge—proposed amendment - a challenge to a legislatively initiated proposed constitutional amendment, but excluding challenges to a citizen-initiated proposed constitutional amendment because the Florida Supreme Court has direct jurisdiction of such challenges. Corporate trusts - all matters relating to the business activities of financial services companies or banks acting in a fiduciary capacity for investors. Discrimination—employment or other – all matters relating to discrimination, including employment, sex, race, age, handicap, harassment, retaliation, or wages. Insurance claims - all matters relating to claims filed with an insurance company. Intellectual property – all matters relating to intangible rights protecting commercially valuable products of the human intellect. Libel/Slander – all matters relating to written, visual, oral, or aural defamation of character. Shareholder derivative action – all matters relating to actions by a corporation’s shareholders to protect and benefit all shareholders against corporate management for improper management. Securities litigation – all matters relating to the financial interest or instruments of a company or corporation. Trade secrets – all matters relating to a formula, process, device, or other business information that is kept confidential to maintain an advantage over competitors. Trust litigation – all civil matters involving guardianships, estates, or trusts and not appropriately filed in probate proceedings. III. Remedies Sought. Place an “X” in the appropriate box. If more than one remedy is sought in the complaint or petition, check all that apply. IV. Number of Causes of Action. If the complaint or petition alleges more than one cause of action, note the number and the name of the cause of action. V. Class Action. Place an “X” in the appropriate box. VI. Related Cases. Place an “X” in the appropriate box. VII. Is Jury Trial Demanded In Complaint? Check the appropriate box to indicate whether a jury trial is being demanded in the complaint ATTORNEY OR PARTY SIGNATURE. Sign the civil cover sheet. Print legibly the name of the person signing the civil cover sheet. Attorneys must include a Florida Bar number. Insert the date the civil cover sheet is signed. Signature is a certification that the filer has provided accurate information on the civil cover sheet. (Form 1.997 Civil Rules of Procedure 1/2010) American LegalNet, Inc. www.FormsWorkFlow.com