JS 44C/SDNY REV. 07/08/16 CIVIL COVER SHEET The JS-44 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, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for use of the Clerk of Court for the purpose of initiating the civil docket sheet. PLAINTIFFS DEFENDANTS ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE NUMBER ATTORNEYS (IF KNOWN) CAUSE OF ACTION (CITE THE U.S. CIVIL STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE ) (DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY) Judge Previously Assigned Has this action, case, or proceeding, or one essentially the same been previously filed in SDNY at any time? No If yes, was this case Vol. Invol. Dismissed. No No Yes Yes Yes If yes, give date _______________________ & Case No. ______________________ IS THIS AN INTERNATIONAL ARBITRATION CASE? (PLACE AN [x] IN ONE BOX ONLY) TORTS NATURE OF SUIT ACTIONS UNDER STATUTES CONTRACT [ [ [ [ ] 110 ] 120 ] 130 ] 140 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 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 MED MALPRACTICE [ ] 150 PERSONAL INJURY [ ] 367 HEALTHCARE/ PHARMACEUTICAL PERSONAL INJURY/PRODUCT LIABILITY [ ] 365 PERSONAL INJURY PRODUCT LIABILITY [ ] 368 ASBESTOS PERSONAL INJURY PRODUCT LIABILITY PERSONAL PROPERTY [ ] 370 OTHER FRAUD [ ] 371 TRUTH IN LENDING FORFEITURE/PENALTY [ ] 625 DRUG RELATED SEIZURE OF PROPERTY 21 USC 881 [ ] 690 OTHER BANKRUPTCY [ ] 422 APPEAL 28 USC 158 [ ] 423 WITHDRAWAL 28 USC 157 OTHER STATUTES [ ] 375 FALSE CLAIMS [ ] 376 QUI TAM [ ] 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 [ ] 850 SECURITIES/ COMMODITIES/ EXCHANGE PROPERTY RIGHTS [ ] 820 COPYRIGHTS [ ] 830 PATENT [ ] 840 TRADEMARK [ ] 151 [ ] 152 SOCIAL SECURITY [ ] 380 OTHER PERSONAL PROPERTY DAMAGE [ ] 385 PROPERTY DAMAGE PRODUCT LIABILITY PRISONER PETITIONS [ ] 463 ALIEN DETAINEE [ ] 510 MOTIONS TO VACATE SENTENCE 28 USC 2255 [ ] 530 HABEAS CORPUS [ ] 535 DEATH PENALTY [ ] 540 MANDAMUS & OTHER LABOR [ ] 710 FAIR LABOR STANDARDS ACT [ ] 720 LABOR/MGMT RELATIONS [ ] 740 RAILWAY LABOR ACT [ ] 751 FAMILY MEDICAL LEAVE ACT (FMLA) [ [ [ [ [ ] 861 HIA (1395ff) ] 862 BLACK LUNG (923) ] 863 DIWC/DIWW (405(g)) ] 864 SSID TITLE XVI ] 865 RSI (405(g)) [ ] 153 [ ] 160 [ ] 190 [ ] 195 FEDERAL TAX SUITS [ ] 890 OTHER STATUTORY ACTIONS [ ] 891 AGRICULTURAL ACTS ACTIONS UNDER STATUTES CIVIL RIGHTS [ ] 440 OTHER CIVIL RIGHTS (Non-Prisoner) [ ] 441 VOTING [ ] 442 EMPLOYMENT [ ] 443 HOUSING/ ACCOMMODATIONS [ ] 445 AMERICANS WITH DISABILITIES EMPLOYMENT [ ] 446 AMERICANS WITH DISABILITIES -OTHER [ ] 448 EDUCATION [ ] 196 [ ] 870 TAXES (U.S. Plaintiff or [ ] 790 OTHER LABOR Defendant) LITIGATION [ ] 871 IRS-THIRD PARTY [ ] 791 EMPL RET INC 26 USC 7609 SECURITY ACT (ERISA) IMMIGRATION REAL PROPERTY [ ] 210 [ ] 220 [ ] 230 [ ] 240 [ ] 245 [ ] 290 LAND CONDEMNATION FORECLOSURE RENT LEASE & EJECTMENT TORTS TO LAND TORT PRODUCT LIABILITY ALL OTHER REAL PROPERTY PRISONER CIVIL RIGHTS [ ] 462 NATURALIZATION [ ] 550 CIVIL RIGHTS APPLICATION [ ] 555 PRISON CONDITION [ ] 465 OTHER IMMIGRATION ACTIONS [ ] 560 CIVIL DETAINEE CONDITIONS OF CONFINEMENT [ ] 893 ENVIRONMENTAL MATTERS [ ] 895 FREEDOM OF INFORMATION ACT [ ] 896 ARBITRATION [ ] 899 ADMINISTRATIVE PROCEDURE ACT/REVIEW OR APPEAL OF AGENCY DECISION [ ] 950 CONSTITUTIONALITY OF STATE STATUTES 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. AS DEFINED BY LOCAL RULE FOR DIVISION OF BUSINESS 13? IF SO, STATE: DEMAND $______________ OTHER ______________ JUDGE _________________________________ DOCKET NUMBER_________________ Check YES only if demanded in complaint JURY DEMAND: YES NO NOTE: You must also submit at the time of filing the Statement of Relatedness form (Form IH-32). American LegalNet, Inc. www.FormsWorkFlow.com (PLACE AN x IN ONE BOX ONLY) ORIGIN 3 Remanded from Appellate Court 1 Original Proceeding 2 Removed from State Court 4 Reinstated or Reopened 5 Transferred from (Specify District) 6 Multidistrict Litigation (Transferred) 7 Appeal to District Judge from Magistrate Judge a. b. 1 all parties represented At least one party is pro se. 8 Multidistrict Litigation (Direct File) IF DIVERSITY, INDICATE CITIZENSHIP BELOW. (PLACE AN x IN ONE BOX ONLY) U.S. PLAINTIFF 2 U.S. DEFENDANT 3 FEDERAL QUESTION (U.S. NOT A PARTY) BASIS OF JURISDICTION 4 DIVERSITY CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY) (Place an [X] in one box for Plaintiff and one box for Defendant) CITIZEN OF THIS STATE CITIZEN OF ANOTHER STATE PTF [ ]1 [ ]2 DEF [ ]1 [ ]2 CITIZEN OR SUBJECT OF A FOREIGN COUNTRY INCORPORATED or PRINCIPAL PLACE OF BUSINESS IN THIS STATE PTF DEF [ ]3[ ]3 [ ]4[ ]4 INCORPORATED and PRINCIPAL PLACE OF BUSINESS IN ANOTHER STATE FOREIGN NATION PTF [ ]5 [ ]6 DEF [ ]5 [ ]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: COURTHOUSE ASSIGNMENT I hereby certify that this case should be assigned to the courthouse indicated below pursuant to Local Rule for Division of Business 18, 20 or 21. DO NOT check either box if this is a PRISONER PETITION/PRISONER CIVIL RIGHTS COMPLAINT. Check one: THIS ACTION SHOULD BE ASSIGNED TO: WHITE PLAINS MANHATTAN 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 Jud