Case 2:15-cv-00926-RWS-RSP Document 1-2 Filed 06/02/15 Page 1 of 2 PageID #: 26
` CIVIL COVER SHEET
`JS 44 (Rev. 09/11)
`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
`Incorporated or Principal Place
`Citizen of This State
`’ 1
`’ 1
`’ 4 ’ 4
`of Business In This State
`
`’ 2 U.S. Government
`Defendant
`
`’ 4 Diversity
`(Indicate Citizenship of Parties in Item III)
`
`Citizen of Another State
`
`’ 2
`
`’ 2
`
`Incorporated and Principal Place
`of Business In Another State
`
`’ 5 ’ 5
`
`Citizen or Subject of a
` Foreign Country
`
`’ 3
`
`’ 3
`
`Foreign Nation
`
`’ 6 ’ 6
`
`BANKRUPTCY
`FORFEITURE/PENALTY
`’ 422 Appeal 28 USC 158
`’ 625 Drug Related Seizure
` of Property 21 USC 881 ’ 423 Withdrawal
`’ 690 Other
` 28 USC 157
`
`OTHER STATUTES
`’ 375 False Claims Act
`’ 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
`
`PROPERTY RIGHTS
`’ 820 Copyrights
`’ 830 Patent
`’ 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
`
`IV. NATURE OF SUIT (Place an “X” in One Box Only)
`CONTRACT
`TORTS
` PERSONAL INJURY
` PERSONAL INJURY
`’ 110 Insurance
`’ 120 Marine
`’ 310 Airplane
`’ 365 Personal Injury -
`’ 130 Miller Act
`’ 315 Airplane Product
` Product Liability
`’ 140 Negotiable Instrument
` Liability
`’ 367 Health Care/
`’ 150 Recovery of Overpayment ’ 320 Assault, Libel &
` Pharmaceutical
` & Enforcement of Judgment
` Slander
` Personal Injury
`’ 151 Medicare Act
`’ 330 Federal Employers’
` Product Liability
`’ 152 Recovery of Defaulted
` Liability
`’ 368 Asbestos Personal
` Student Loans
`’ 340 Marine
` Injury Product
`LABOR
` (Excl. Veterans)
`’ 345 Marine Product
` Liability
` PERSONAL PROPERTY ’ 710 Fair Labor Standards
`’ 153 Recovery of Overpayment
` Liability
` of Veteran’s Benefits
`’ 350 Motor Vehicle
`’ 370 Other Fraud
` Act
`’ 160 Stockholders’ Suits
`’ 355 Motor Vehicle
`’ 371 Truth in Lending
`’ 720 Labor/Mgmt. Relations
`’ 190 Other Contract
` Product Liability
`’ 380 Other Personal
`’ 740 Railway Labor Act
`’ 195 Contract Product Liability ’ 360 Other Personal
` Property Damage
`’ 751 Family and Medical
`’ 196 Franchise
` Injury
`’ 385 Property Damage
` Leave Act
`’ 362 Personal Injury -
` Product Liability
`’ 790 Other Labor Litigation
` Med. Malpractice
`’ 791 Empl. Ret. Inc.
` PRISONER PETITIONS
` CIVIL RIGHTS
` Security Act
`’ 510 Motions to Vacate
`’ 440 Other Civil Rights
` Sentence
`’ 441 Voting
`Habeas Corpus:
`’ 442 Employment
`’ 530 General
`’ 443 Housing/
`IMMIGRATION
`’ 535 Death Penalty
` Accommodations
`’ 445 Amer. w/Disabilities - ’ 540 Mandamus & Other ’ 462 Naturalization Application
` Employment
`’ 550 Civil Rights
`’ 463 Habeas Corpus -
`’ 446 Amer. w/Disabilities - ’ 555 Prison Condition
` Alien Detainee
` Other
`’ 560 Civil Detainee -
` (Prisoner Petition)
`’ 465 Other Immigration
`’ 448 Education
` Conditions of
` Confinement
` Actions
`
` REAL PROPERTY
`’ 210 Land Condemnation
`’ 220 Foreclosure
`’ 230 Rent Lease & Ejectment
`’ 240 Torts to Land
`’ 245 Tort Product Liability
`’ 290 All Other Real Property
`
`V. ORIGIN
`’ 1 Original
`Proceeding
`
`VI. CAUSE OF ACTION
`
` (Place an “X” in One Box Only)
`Transferred from
`’ 4 Reinstated or
`’ 2 Removed from
`’ 3 Remanded from
`another district
`Reopened
`State Court
`Appellate Court
`(specify)
`Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):
`
`Brief description of cause:
`
`’ 5
`
`’ 6 Multidistrict
`Litigation
`
`VII. REQUESTED IN
` COMPLAINT:
`VIII. RELATED CASE(S)
` IF ANY
`DATE
`
`FOR OFFICE USE ONLY
`
`’ CHECK IF THIS IS A CLASS ACTION
`UNDER F.R.C.P. 23
`
`DEMAND $
`
`CHECK YES only if demanded in complaint:
`’ Yes
`’ No
`JURY DEMAND:
`
`(See instructions):
`
`JUDGE
`
`DOCKET NUMBER
`
`SIGNATURE OF ATTORNEY OF RECORD
`
`RECEIPT #
`
`AMOUNT
`
`APPLYING IFP
`
`JUDGE
`
`MAG. JUDGE
`
`

`
`Case 2:15-cv-00926-RWS-RSP Document 1-2 Filed 06/02/15 Page 2 of 2 PageID #: 27
`JS 44 Reverse (Rev. 09/11)
`
`INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44
`
`Authority For Civil Cover Sheet
`The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading 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. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil
`complaint filed. The attorney filing a case should complete the form as follows:
`I.
`(a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only
`the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving
`both name and title.
`(b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the
`time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation
`cases, the county of residence of the “defendant” is the location of the tract of land involved.)
`(c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting
`in this section “(see attachment)”.
` II.
`Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires that jurisdictions be shown in pleadings. Place an “X” in one
`of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below.
`United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here.
`United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an “X” in this box.
`Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the
`Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box
`1 or 2 should be marked.
`Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of
`the different parties must be checked. (See Section III below; federal question actions take precedence over diversity cases.)
`III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this section
`for each principal party.
`IV.
`Nature of Suit. Place an “X” in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is
`sufficient to enable the deputy clerk or the statistical clerks in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of
`suit, select the most definitive.
`V.
`Origin. Place an “X” in one of the seven boxes.
`Original Proceedings. (1) Cases which originate in the United States district courts.
`Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition
`for removal is granted, check this box.
`Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date.
`Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date.
`Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict
`litigation transfers.
`Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this
`box is checked, do not check (5) above.
`Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judge’s decision.
`VI.
`Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes
`unless diversity.
`Example:
`U.S. Civil Statute: 47 USC 553
`Brief Description: Unauthorized reception of cable service
`VII. Requested in Complaint. Class Action. Place an “X” in this box if you are filing a class action under Rule 23, F.R.Cv.P.
`Demand. In this space enter the dollar amount (in thousands of dollars) being demanded or indicate other demand such as a preliminary injunction.
`Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded.
`VIII. Related Cases. This section of the JS 44 is used to reference related pending cases if any. If there are related pending cases, insert the docket numbers
`and the corresponding judge names for such cases.
`Date and Attorney Signature. Date and sign the civil cover sheet.