JS 44 (Rev. 06/17)
`
`Case 1:19-cv-11272-RGS Document 1-3 Filed 06/07/19 Page 1 of 1
` 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 the use of the Clerk of Court for the
`purpose of initiating the civil docket sheet.
`(SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.)
`
`I. (a) PLAINTIFFS
`
`DEFENDANTS
`
`(b) County of Residence of First Listed Plaintiff
`(EXCEPT IN U.S. PLAINTIFF CASES)
`
`County of Residence of First Listed Defendant
`(IN U.S. PLAINTIFF CASES ONLY)
`IN LAND CONDEMNATION CASES, USE THE LOCATION OF
`THE TRACT OF LAND INVOLVED.
`
`NOTE:
`
`(c) Attorneys (Firm Name, Address, and Telephone Number)
`
` Attorneys (If Known)
`
`II. BASIS OF JURISDICTION (Place an “X” in One Box Only)
`
`1 U.S. Government
`Plaintiff
`
`3 Federal Question
`(U.S. Government Not a Party)
`
`III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X” in One Box for Plaintiff
`(For Diversity Cases Only)
` and One Box for Defendant)
` PTF DEF
` PTF
` DEF
`Citizen of This State
`1
` 1
`Incorporated or Principal Place
`4
` of Business In This State
`
`4
`
`2 U.S. Government
`Defendant
`
`4 Diversity
`(Indicate Citizenship of Parties in Item III)
`
`Citizen of Another State
`
`IV. NATURE OF SUIT (Place an “X” in One Box Only)
`CONTRACT
`TORTS
`
`110 Insurance
`120 Marine
`130 Miller Act
`140 Negotiable Instrument
`150 Recovery of Overpayment
` & Enforcement of Judgment
`151 Medicare Act
`152 Recovery of Defaulted
` Student Loans
` (Excludes Veterans)
`153 Recovery of Overpayment
` of Veteran’s Benefits
`160 Stockholders’ Suits
`190 Other Contract
`195 Contract Product Liability
`196 Franchise
`
` REAL PROPERTY
`210 Land Condemnation
`220 Foreclosure
`230 Rent Lease & Ejectment
`240 Torts to Land
`245 Tort Product Liability
`290 All Other Real Property
`
` 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 -
` Medical Malpractice
` CIVIL RIGHTS
`440 Other Civil Rights
`441 Voting
`442 Employment
`443 Housing/
` Accommodations
`445 Amer. w/Disabilities -
` Employment
`446 Amer. w/Disabilities -
` Other
`448 Education
`
`PERSONAL INJURY
`365 Personal Injury -
` Product Liability
`367 Health Care/
` Pharmaceutical
` Personal Injury
` Product Liability
`368 Asbestos Personal
` Injury Product
` Liability
` PERSONAL PROPERTY
`370 Other Fraud
`371 Truth in Lending
`380 Other Personal
` Property Damage
`385 Property Damage
` Product Liability
`
` PRISONER PETITIONS
`Habeas Corpus:
`463 Alien Detainee
`510 Motions to Vacate
` Sentence
`530 General
`535 Death Penalty
`Other:
`540 Mandamus & Other
`550 Civil Rights
`555 Prison Condition
`560 Civil Detainee -
` Conditions of
` Confinement
`
`Citizen or Subject of a
` Foreign Country
`
`FORFEITURE/PENALTY
`
`625 Drug Related Seizure
` of Property 21 USC 881
`690 Other
`
`LABOR
`710 Fair Labor Standards
` Act
`720 Labor/Management
` Relations
`740 Railway Labor Act
`751 Family and Medical
` Leave Act
`790 Other Labor Litigation
`791 Employee Retirement
` Income Security Act
`
`IMMIGRATION
`462 Naturalization Application
`465 Other Immigration
` Actions
`
`2
`
`3
`
` 2
`
`Incorporated and Principal Place
`of Business In Another State
`
` 3
`
`Foreign Nation
`
`5
`
`6
`
`5
`
`6
`
`Click here for: Nature of Suit Code Descriptions.
`BANKRUPTCY
`OTHER STATUTES
`
`422 Appeal 28 USC 158
`423 Withdrawal
` 28 USC 157
`
`PROPERTY RIGHTS
`820 Copyrights
`830 Patent
`835 Patent - Abbreviated
` New Drug Application
`840 Trademark
`SOCIAL SECURITY
`861 HIA (1395ff)
`862 Black Lung (923)
`863 DIWC/DIWW (405(g))
`864 SSID Title XVI
`865 RSI (405(g))
`
`FEDERAL TAX SUITS
`870 Taxes (U.S. Plaintiff
` or Defendant)
`871 IRS—Third Party
` 26 USC 7609
`
`375 False Claims Act
`376 Qui Tam (31 USC
` 3729(a))
`400 State Reapportionment
`410 Antitrust
`430 Banks and Banking
`450 Commerce
`460 Deportation
`470 Racketeer Influenced and
` Corrupt Organizations
`480 Consumer Credit
`490 Cable/Sat TV
`850 Securities/Commodities/
` Exchange
`890 Other Statutory Actions
`891 Agricultural Acts
`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
`
`V. ORIGIN (Place an “X” in One Box Only)
`1 Original
`2 Removed from
`Proceeding
`State Court
`
` 3 Remanded from
`Appellate Court
`
`4 Reinstated or
`Reopened
`
` 5 Transferred from
`Another District
`(specify)
`Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):
`
` 6 Multidistrict
`Litigation -
`Transfer
`
`8 Multidistrict
` Litigation -
` Direct File
`
`VI. CAUSE OF ACTION
`
`Brief description of cause:
`
`VII. REQUESTED IN
` COMPLAINT:
`VIII. RELATED CASE(S)
` IF ANY
`
`CHECK IF THIS IS A CLASS ACTION
`UNDER RULE 23, F.R.Cv.P.
`
`DEMAND $
`
`CHECK YES only if demanded in complaint:
`Yes
`No
`JURY DEMAND:
`
`(See instructions):
`
`JUDGE
`
`DOCKET NUMBER
`
`DATE
`
`SIGNATURE OF ATTORNEY OF RECORD
`
`FOR OFFICE USE ONLY
`
`RECEIPT #
`
`AMOUNT
`
`APPLYING IFP
`
`JUDGE
`
`MAG. JUDGE
`
`