JS 44C/SDNY
`REV.
`10/01/2020
`
`PLAINTIFFS
`
`Case 1:22-cv-02229-MKV Document 4 Filed 03/18/22 Page 1 of 2
`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.
`
`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`(DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY)
`
`Has this action, case, or proceeding, or one essentially the same been previously filed in SDNY at any time? No Yes
`
`Judge Previously Assigned
`
`If yes, was this case Vol.
`
` Invol.
`
`Dismissed. No
`
`Yes
`
`If yes, give date _______________________ & Case No. ______________________
`
`IS THIS AN INTERNATIONAL ARBITRATION CASE?
`(PLACE AN [x] IN ONE BOX ONLY)
`
` No
`
`Yes
`NATURE OF SUIT
`
`TORTS
`
`ACTIONS UNDER STATUTES
`
`CONTRACT
`
`PERSONAL INJURY
`
`[ ] 110
`[ ] 120
`[ ] 130
`[ ] 140
`
`[ ] 150
`
`[ ] 151
`[ ] 152
`
`[ ] 153
`
`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
`[ ] 196 FRANCHISE
`
`[ ] 160
`
`[ ] 190
`
`[ ] 195
`
`[ ] 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
`
`ACTIONS UNDER STATUTES
`
`CIVIL RIGHTS
`
`REAL PROPERTY
`
`[ ] 210
`
`[ ] 220
`[ ] 230
`
`[ ] 240
`[ ] 245
`
`[ ] 290
`
`LAND
`CONDEMNATION
`FORECLOSURE
`RENT LEASE &
`EJECTMENT
`TORTS TO LAND
`TORT PRODUCT
`LIABILITY
`ALL OTHER
`REAL PROPERTY
`
`[ ] 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
`
`PRISONER CIVIL RIGHTS
`
`[ ] 440 OTHER CIVIL RIGHTS
`(Non-Prisoner)
`[ ] 441 VOTING
`[ ] 442 EMPLOYMENT
`[ ] 443 HOUSING/
`ACCOMMODATIONS
`[ ] 550 CIVIL RIGHTS
`[ ] 445 AMERICANS WITH
`[ ] 555 PRISON CONDITION
`DISABILITIES -
`[ ] 560 CIVIL DETAINEE
`EMPLOYMENT
`CONDITIONS OF CONFINEMENT
`[ ] 446 AMERICANS WITH
`DISABILITIES -OTHER
`[ ] 448 EDUCATION
`
`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
`
`BANKRUPTCY
`
`[ ] 625 DRUG RELATED
`SEIZURE OF PROPERTY
`21 USC 881
`[ ] 690 OTHER
`
`PROPERTY RIGHTS
`
`[ ] 422 APPEAL
`28 USC 158
`[ ] 423 WITHDRAWAL
`28 USC 157
`
`[ ] 880 DEFEND TRADE SECRETS ACT
`
`[ ] 820 COPYRIGHTS
`[ ] 830 PATENT
`[ ] 835 PATENT-ABBREVIATED NEW DRUG APPLICATION
`[ ] 840 TRADEMARK
`
`SOCIAL SECURITY
`
`LABOR
`
`[ ] 710 FAIR LABOR
`STANDARDS ACT
`[ ] 720 LABOR/MGMT
`RELATIONS
`[ ] 740 RAILWAY LABOR ACT
`[ ] 751 FAMILY MEDICAL
`LEAVE ACT (FMLA)
`[ ] 790 OTHER LABOR
`LITIGATION
`[ ] 791 EMPL RET INC
`SECURITY ACT (ERISA)
`
`[ ] 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
`
`IMMIGRATION
`
`[ ] 462 NATURALIZATION
`APPLICATION
`[ ] 465 OTHER IMMIGRATION
`ACTIONS
`
`OTHER STATUTES
` [ ] 375 FALSE CLAIMS
` [ ] 376 QUI TAM
`[ ] 400 STATE
`REAPPORTIONMENT
`[ ] 410 ANTITRUST
`[ ] 430 BANKS & BANKING
`[ ] 450 COMMERCE
`[ ] 460 DEPORTATION
`[ ] 470 RACKETEER INFLU-
`ENCED & CORRUPT
`ORGANIZATION ACT
`(RICO)
`[ ] 480 CONSUMER CREDIT
`[ ] 485 TELEPHONE CONSUMER
` PROTECTION ACT
`
`[ ] 490 CABLE/SATELLITE 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
`
`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).
`
`

`

`Case 1:22-cv-02229-MKV Document 4 Filed 03/18/22 Page 2 of 2
`ORIGIN
`4 Reinstated or
`Reopened
`
`6
`
`Multidistrict
`Litigation
`(Transferred)
`
`7
`
`Appeal to District
`Judge from
`Magistrate Judge
`
`8
`
`Multidistrict Litigation (Direct File)
`
`IF DIVERSITY, INDICATE
`CITIZENSHIP BELOW.
`
`(PLACE AN x IN ONE BOX ONLY)
`1 Original
`2 Removed from
`Proceeding
`State Court
`a. all parties represented
`b. At least one party
`is pro se.
`(PLACE AN x IN ONE BOX ONLY)
`1 U.S. PLAINTIFF
`2 U.S. DEFENDANT
`
`3 Remanded
`from
`Appellate
`Court
`
`5 Transferred from
`(Specify District)
`
`BASIS OF JURISDICTION
`3 FEDERAL QUESTION
`4 DIVERSITY
`(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)
`
`CITIZEN OF THIS STATE
`
`PTF DEF
`[ ] 1
`[ ] 1
`
`CITIZEN OR SUBJECT OF A
` FOREIGN COUNTRY
`
`PTF DEF
`[ ] 3 [ ] 3
`
`INCORPORATED and PRINCIPAL PLACE
`OF BUSINESS IN ANOTHER STATE
`
`CITIZEN OF ANOTHER STATE [ ] 2
`
`[ ] 2
`
`INCORPORATED or PRINCIPAL PLACE
` OF BUSINESS IN THIS STATE
`
`[ ] 4 [ ] 4
`
`FOREIGN NATION
`
`PTF DEF
`[ ] 5
`[ ] 5
`
`[ ] 6
`
`[ ] 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.
`
`Check one:
`
`THIS ACTION SHOULD BE ASSIGNED TO:
`
`WHITE PLAINS
`
`MANHATTAN
`
`DATE
`
`RECEIPT #
`
`SIGNATURE OF ATTORNEY OF RECORD
`
`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.
`
`Ruby J. Krajick, Clerk of Court by _____________ Deputy Clerk, DATED _____________________.
`
`UNITED STATES DISTRICT COURT (NEW YORK SOUTHERN)
`
`