JS 44C/SDNY REV. 1/2008 CIVIL COVER SHEET T he JS-44 civil cover sheet and the inform ation contained herein neither replace nor supplem ent the filing and service of pleadings or other papers as required by law, except as provided by local rules of court. This form , approved by the Judicial C onference of the U nited S tates in S eptem ber 1974, is required for use of the C lerk of C ourt for the purpose of initiating the civil dock et sheet. PLAINTIFFS DEFENDANTS ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE NUMBER) ATTORNEYS (IF KNOWN) CAUSE OF ACTION (C IT E T H E U .S . C IV IL S TA T U T E U N D ER W H IC H YO U A R E FILIN G A N D W R IT E A B R IE F S TA T E M E N T O F C A U S E ) (D O NO T C ITE JU R ISD IC TIO N AL STA TU TE S U N LESS D IVE R SIT Y) Has this or a similar case been previously filed in SDNY at any time? No? If yes, was this case Vol. Invol. Dismissed. No (PLACE AN [x] IN ONE BOX ONLY) Yes Judge Previously Assigned ______________________________ Yes? If yes, give date _______________________ & Case No. ______________________ NATURE OF SUIT TORTS ACTIONS UNDER STATUTES CONTRACT PERSONAL INJURY PERSONAL INJURY [ [ [ [ [ ] 310 AIRPLANE [ ] 315 AIRPLANE PRODUCT LIABILITY [ ] 320 ASSAULT, LIBEL & SLANDER [ ] 330 FEDERAL EMPLOYERS' LIABILITY [ ] 340 MARINE [ ] 345 MARINE PRODUCT LIABILITY [ ] 350 MOTOR VEHICLE [ ] 355 MOTOR VEHICLE PRODUCT LIABILITY [ ] 360 OTHER PERSONAL INJURY [ ] 362 PERSONAL INJURY - [ ] 610 MED MALPRACTICE [ ] 620 [ ] 365 PERSONAL INJURY PRODUCT LIABILITY [ ] 625 [ ] 368 ASBESTOS PERSONAL INJURY PRODUCT LIABILITY [ ] 630 PERSONAL PROPERTY [ ] 640 [ ] 650 [ ] 660 [ ] 370 OTHER FRAUD [ ] 371 TRUTH IN LENDING [ ] 690 [ ] 380 OTHER PERSONAL PROPERTY DAMAGE [ ] 385 PROPERTY DAMAGE PRODUCT LIABILITY LABOR ] 110 ] 120 ] 130 ] 140 [ ] 150 [ ] 151 [ ] 152 [ ] 153 [ ] 160 [ ] 190 [ ] 195 [ ] 196 INSURANCE MARINE MILLER ACT NEGOTIABLE INSTRUMENT RECOVERY OF OVERPAYMENT & ENFORCEMENT OF JUDGMENT MEDICARE ACT RECOVERY OF DEFAULTED STUDENT LOANS (EXCL VETERANS) RECOVERY OF OVERPAYMENT OF VETERAN'S BENEFITS STOCKHOLDERS SUITS OTHER CONTRACT CONTRACT PRODUCT LIABILITY FRANCHISE REAL PROPERTY [ ] 210 [ ] 220 [ ] 230 [ ] 240 [ ] 245 [ ] 290 LAND CONDEMNATION FORECLOSURE RENT LEASE & EJECTMENT TORTS TO LAND TORT PRODUCT LIABILITY ALL OTHER REAL PROPERTY FORFEITURE/PENALTY [ ] 710 [ ] 720 [ ] 730 ACTIONS UNDER STATUTES CIVIL RIGHTS PRISONER PETITIONS [ ] 441 VOTING [ ] 442 EMPLOYMENT [ ] 443 HOUSING/ ACCOMMODATIONS [ ] 444 WELFARE [ ] 445 AMERICANS WITH DISABILITIES EMPLOYMENT [ ] 446 AMERICANS WITH DISABILITIES -OTHER [ ] 440 OTHER CIVIL RIGHTS [ ] 510 MOTIONS TO VACATE SENTENCE 28 USC 2255 [ ] 530 HABEAS CORPUS [ ] 535 DEATH PENALTY [ ] 540 MANDAMUS & OTHER [ ] 550 CIVIL RIGHTS [ ] 555 PRISON CONDITION [ ] 740 [ ] 790 [ ] 791 AGRICULTURE OTHER FOOD & DRUG DRUG RELATED SEIZURE OF PROPERTY 21 USC 881 LIQUOR LAWS RR & TRUCK AIRLINE REGS OCCUPATIONAL SAFETY/HEALTH OTHER [ ] 463 [ ] 465 OTHER STATUTES [ ] 422 APPEAL 28 USC 158 [ ] 423 WITHDRAWAL 28 USC 157 [ ] 400 STATE REAPPORTIONMENT [ ] 410 ANTITRUST [ ] 430 BANKS & BANKING [ ] 450 COMMERCE [ ] 460 DEPORTATION [ ] 470 RACKETEER INFLUENCED & CORRUPT ORGANIZATION ACT (RICO) [ ] 480 CONSUMER CREDIT [ ] 490 CABLE/SATELLITE TV [ ] 810 SELECTIVE SERVICE [ ] 850 SECURITIES/ COMMODITIES/ EXCHANGE [ ] 875 CUSTOMER CHALLENGE 12 USC 3410 [ ] 890 OTHER STATUTORY ACTIONS [ ] 891 AGRICULTURAL ACTS [ ] 892 ECONOMIC STABILIZATION ACT [ ] 893 ENVIRONMENTAL MATTERS [ ] 894 ENERGY ALLOCATION ACT [ ] 895 FREEDOM OF INFORMATION ACT [ ] 900 APPEAL OF FEE DETERMINATION UNDER EQUAL ACCESS TO JUSTICE [ ] 950 CONSTITUTIONALITY OF STATE STATUTES PROPERTY RIGHTS [ ] 820 COPYRIGHTS [ ] 830 PATENT [ ] 840 TRADEMARK SOCIAL SECURITY [ [ [ [ [ ] 861 ] 862 ] 863 ] 864 ] 865 HIA (1395ff) BLACK LUNG (923) DIWC/DIWW (405(g)) SSID TITLE XVI RSI (405(g)) FAIR LABOR STANDARDS ACT LABOR/MGMT RELATIONS LABOR/MGMT REPORTING & FEDERAL TAX SUITS DISCLOSURE ACT RAILWAY LABOR ACT [ ] 870 TAXES (U.S. Plaintiff or OTHER LABOR Defendant) LITIGATION [ ] 871 IRS-THIRD PARTY EMPL RET INC 26 USC 7609 SECURITY ACT IMMIGRATION [ ] 462 BANKRUPTCY NATURALIZATION APPLICATION HABEAS CORPUSALIEN DETAINEE OTHER IMMIGRATION ACTIONS Check if demanded in complaint: CHECK IF THIS IS A CLASS ACTION UNDER F.R.C.P. 23 DO YOU CLAIM THIS CASE IS RELATED TO A CIVIL CASE NOW PENDING IN S.D.N.Y.? IF SO, STATE: DEMAND $______________ OTHER ______________ JUDGE _________________________________ DOCKET NUMBER_________________ Check YES only if demanded in complaint JURY DEMAND: YES NO NOTE: Please submit at the time of filing an explanation of why cases are deemed related. American LegalNet, Inc. www.FormsWorkflow.com (PLACE AN x IN ONE BOX ONLY) 1 ORIGIN 2 a. R em oved from O riginal P roceeding 3 State C ourt R em anded from A ppellate C ourt 4 R einstated or R eopened 5 T ransferred from (S pecify D istrict) 6 7 M ultidistrict Litigation 2b.R em oved from State C ourt AN D at least one party is pro se. (PLACE AN x IN ONE BOX ONLY) 1 U.S. PLAINTIFF 2 U.S. DEFENDANT BASIS OF JURISDICTION 3 FEDERAL QUESTION 4 DIVERSITY A ppeal to D istrict Judge from M agistrate Judge Judgm ent IF DIVERSITY, INDICATE CITIZENSHIP BELOW. (28 USC 1322, 1441) (U.S. NOT A PARTY) CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY) (Place an [X] in one box for Plaintiff and one box for Defendant) C IT IZE N O F TH IS S T A T E PTF [ ]1 DEF [ ]1 C IT IZE N O F AN O T H E R S T A T E [ ]2 [ ]2 PTF DEF [ ]3 [ ]3 C IT IZE N O R S U B JE C T O F A FO R E IG N C O U N T R Y IN C O R P O R A T E D or P R IN C IP A L P LA C E O F B U S IN E S S IN T H IS S T A T E [ ]4 [ ]4 FO R E IG N N A T IO N PTF [ ]5 DEF [ ]5 [ ]6 IN C O R P O R A T E D and P R IN C IP A L P LA C E O F B U S IN E S S IN A N O T H E R S T A T E [ ]6 PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES) DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES) DEFENDANT(S) ADDRESS UNKNOWN REPRESENTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DILIGENCE, TO ASCERTAIN THE RESIDENCE ADDRESSES OF THE FOLLOWING DEFENDANTS: Check one: THIS ACTION SHOULD BE ASSIGNED TO: WHITE PLAINS MANHATTAN (DO NOT check either box if this a PRISONER PETITION.) DATE SIGNATURE OF ATTORNEY OF RECORD RECEIPT # ADMITTED TO PRACTICE IN THIS DISTRICT [ ] NO [ ] YES (DATE ADMITTED Mo. _______ Yr. _______) Attorney Bar Code # Magistrate Judge is to be designated by the Clerk of the Court. Magistrate Judge _________________________________________________________ is so Designated. J. Michael McMahon, Clerk of Court by _____________ Deputy Clerk, DATED _____________________. UNITED STATES DISTRICT COURT (NEW YORK SOUTHERN) American LegalNet, Inc. www.FormsWorkflow.com