Rule 1.1901--Form 16: Expedited Civil Action Certification Save Print Instructions Clear Form In the Iowa District Court for Civil case no. County Plaintiff Full name of Plaintiff: first, middle, last Expedited Civil Action Certification vs. Defendant Full name of Defendant: first, middle, last Plaintiff, Name of Plaintiff , together with Plaintiff's attorney, , elect to bring this lawsuit as an Expedited Name of attorney 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. Plaintiff certifies the following: 1. 2. 3. I am a plaintiff in this action. If I am represented by an attorney, I have conferred with my 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 my 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 me, 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 I may be entitled. 4. With this knowledge, I agree to proceed under the Expedited Civil Action procedures. Dated this day of , 20 . ___________________________________ Plaintiff January 2015 Rule 1.1901--Form 16 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Rule 1.1901--Form 16: Expedited Civil Action Certification, continued Oath and Signatures I, Print Plaintiff's name , 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: first, middle, last Handwritten signature of Plaintiff Plaintiff's attorney's name, if applicable Signature of attorney, if applicable Law firm, if applicable Mailing addr. of attorney (or Plaintiff if unrepresented) Telephone no. of attorney (or Plaintiff if unrepresented) Email address of attorney (or Plaintiff if unrepresented) Additional email address, if available January 2015 Rule 1.1901--Form 16 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com