Rule 1.1901--Form 17: Alternative Expedited Civil Action Certification In the Iowa District Court for Civil case no. County Plaintiff Full name of Plaintiff: first, middle, last vs. Alternative Expedited Civil Action Certification for Plaintiffs that Are Not Natural Persons or Otherwise Must Act Through a Representative Defendant Full name of Defendant: first, middle, last Plaintiff, Name of Plaintiff Name of attorney , together with Plaintiff's attorney, , elect to bring this lawsuit as an Expedited Civil Action under Iowa Rule of Civil Procedure 1.281. Plaintiff certifies that the sole relief sought is a money judgment and that all claims (other than compulsory counterclaims) for all damages by or against any one party total $75,000 or less, including damages of any kind, penalties, prefiling interest, and attorney fees, but excluding prejudgment interest accrued after the filing date, postjudgment interest, and costs. The undersigned person certifies the following: 1. I am the _____________ of Plaintiff in this action. I am duly authorized to execute this Title certification. 2. 3. If Plaintiff is represented by an attorney, I have conferred with that attorney about using the Expedited Civil Action procedures available to parties in the State of Iowa. I understand that by electing to proceed under Expedited Civil Action procedures, the total amount of Plaintiff's recovery will not exceed $75,000, excluding prejudgment interest accrued after the filing, postjudgment interest, and court costs. Additionally, no single defendant can be liable for more than $75,000 to all plaintiffs combined, excluding prejudgment interest accrued after the filing, postjudgment interest, and court costs. I understand that if a jury were to award more than $75,000 as damages to Plaintiff, or if a jury were to award more than $75,000 in total against a single defendant, the trial judge would reduce the amount of the judgment to $75,000, plus any applicable interest and court costs to which Plaintiff may be entitled. 4. Continued on next page January 2015 Rule 1.1901--Form 17 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Rule 1.1901--Form 17: Alternative Expedited Civil Action Certification, continued With this knowledge, Plaintiff agrees to proceed under the Expedited Civil Action procedures. Dated this day of Month , 20 Year . Plaintiff ___________________________________________ Name and title of Plaintiff's representative signing this form Oath and Signature I, Print name of Plaintiff's representative , certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. , 20 Month Day Year Full name of Plaintiff's representative Handwritten signature of Plaintiff's representative Name of attorney Signature of attorney Name of law firm Mailing address of attorney Telephone number of attorney Email address of attorney Additional email address, if available January 2015 Rule 1.1901--Form 17 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com