SUPPLEMENTAL CIVIL COVER SHEET FOR CASES REMOVED FROM STATE COURT This form must be attached to the Civil Cover Sheet at the time the case is filed in the United States District Court State Court County: _______________________________________ Case number and caption: _________________ Case Number _________________ Plainfiff(s) vs _________________ Defendant(s) Jury Demand Made in State Court: If "Yes," by which party and on what Date: Yes No _____________________________________ Party _________________ Date Were there parties not served prior to removal? Were there parties dismissed/terminated prior to removal? Were there answers filed in State Court? Is there a pending TRO in State Court? Yes Yes Yes Yes No No No No If you have answered "yes" to any of the above please list parties not served, the parties dismissed/terminated and the parties that filed their answers on the reverse of this page. On the reverse of this page please list all Plaintiff(s), Defendant(s), Intervenor(s), Counterclaimant(s), Crossclaimant(s) and Third Party Claimant(s) still remaining in the case and indicate their party type. Please list the attorney(s) of record for each party named and include their bar number, firm name, correct mailing address and phone number, including area code. Are copies of all state case pleadings attached to your removal? If your answer is "No", when will they be filed: List the parties that are removing the case: Yes No _________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ______________________________________ ______________________________________ ______________________________________ -1- American LegalNet, Inc. www.FormsWorkflow.com Parties Not Served I.E. Defendant John Doe Parties Dismissed I.E. Defendant John Doe Answers Filed I.E. Defendant John Doe Party and Type I.E. Plaintiff John Doe I.E. Attorney(s) Attorney(s) Name Firm Address City, State, Zip Telephone and Fax Number Supreme Court Number USE A SEPARATE SHEET OF PAPER IF NECESSARY -2American LegalNet, Inc. www.FormsWorkflow.com