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civil cover sheet

JS 44C/SDNY

REV. 1/97

WEB 4.99

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

  Name of Plaintiff(s)

defendants

  Name of Defendant(s)

 

 

attorneys (firm name, address, adn telephone number)

  Plaintiff's attorney

 

attorneys (if known)

  Defendant's attorney

 

 

cause  of action (cite the u.s. civil statute under which you are filing and write a brief statement of cause)

  basis for subject matter jurisdiction or other federal statute (i.e. 42 U.S.C. Section 1983)

 

 

Has this or a similar case been previously filed in SNDY at any time?  No?  ?   Yes?  ?  Judge Previously Assigned__________________

 

If yes, was this case Vol. ?  Invol. D?  ismissed.  No ?  Yes ?  If yes, give date ___________________ & Case No._________________

 

(place an (x) in one box only)                                                               NATURE OF SUIT

 

                                                                                                                                                ACTIONS UNDER STATUTES

 

 

TORTS

FORFEITURE/PENALTY

BANKRUPTCY

OTHER STATUTES

 

CONTRACT

PERSONAL INJURY

PERSONAL INJURY

[ ] 610 agriculture

[ ] 620 food & drug

[ ] 625 drug related

               seizure of

               property

               21 usc 881

[ ] 630 liquor laws

[ ] 640 rr & truck

[ ] 650 airline regs

[ ] 660 occupational

               safety/health

[ ] 690 other

 

labor

[

[ ] 710 fair labor

                standards act

[ ] 720 labor/mgmt

               relations

[ ] 730 labor/mgmt

               reporting & 

               disclosure act

[ ] 740 railway labor act

[ ] 790 other labor

               litigation

[ ] 791 empl ret inc

               security act

[ ] 422 appeal

               28 usc 158

[ ] 423 withdrawal

               28 usc 157

 

property rights

 

[ ] 820 copyrights

[ ] 830 patent

[ ] 840 trademark

 

social security

 

[ ] 861 mia (1395ff)

[ ] 862 black lung                (923)

[ ] 863 diwc (405(g))

[ ] 863 diww (4059g))

[ ] 864 ssid title xvi

[ ] 865 rsi (405(g))

 

federal tax suits

 

[ ] 870 taxes

[ ] 871 irs-third party

               20 usc 7609

[ ] 400 state                reapportionment

[ ] 410 antitrust

[ ] 430 banks & banking

[ ] 450 commerce/icc

               rates/etc

[ ] 460 deportation

[ ] 470 racketeer influ-

               enced & corrupt

               organization act

               (rico)

[ ] 810 selective service

[ ] 850 securities/

               commodities/

               exchange

[ ] 875 customer

               challenge

               12 usc 3410

[ ] 891 agriculture acts

[ ] 892 economic

               stabilizaiton act

[ ] 893 environmental

               matters

[ ] 894 energy

               allocation act

[ ] 895 freedom of

               information act

[ ] 900 appeal of fee

               determination                under equal                access to justice

[ ] 950 constitutionality                of state statutes

[ ] 890 other statutory

               actions

 

 

 

 

 

[ ] 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

             (excl veterans)

[ ] 153 recovery of

             overpayment of

             veteran's benefits

[ ] 160 stockholders

             suits

[ ] 190 other contract

[ ] 195 contract product

             liability

 

 

 

real property

 

[ ] 210 land

             condemnation

[ ] 220 foreclosure

[ ] 230 rent lease &

             ejectment

[ ] 240 torts to land

[ ] 246 tort product

              liability

[ ] 290 all other

              real property

[ ] 310 airplane

[ ] 315 airplane                product  liability

[ ] 320 assault, libel &

               slander

[ ] 350 Federal

               employers'

               liability

[ ] 340 marine

[ ] 345 marine product

               liability

[ ] 350 motor vehicle

[ ] 355 motor vehicle

               product liability

[ ] 360  Other personal

               injury

 

 

 

 

 

 

 

actions under statutes

 

civil rights

 

[ ] 441 voting

[ ] employment

[ ] 443 housing

               accommodations

[ ] 444 welfare

[ ] 440 other civil rights

 

[ ] 362 personal injury

               med malpractice

[ ] 365 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

 

[ ] 510 motions to

               vacate sentence

               20 usc 2255

[ ] 530 habeas corpus

[ ] 535 death penalty

[ ] 540 mandamus &

               other

[ ] 550 civil rights

[ ] 555 prison condition

            Check if demanded in complaint:

            check if this is a class action                          do you claim this case is related to a civil case now pending in s.d.n.y.?

        under f.r.c.p. 23                                                if so, state:

demand $amt or "yes"  other  injunct/decia              judge______________________________________ docket number_________________________

Check YES only if demanded in complaint

JURY DEMAND: 
 YES 
 NO                                                              NOTE:  Please submit at the time of filing an explanation of why cases are deemed related.

(see reverse)


(PLACE AN X IN ONE BOX ONLY)                                                                      origin


 1 Original                        
 2 Removed from                    
 3 Remanded from               
 4 Reinstated or   
 5 Transferred from           
 6 Multidistrict       
 
7.Appeal to District

        Proceeding                              State Court                                   Appellate Court                      Reopened                   (Specify District)                 Litigation                        Judge from

                                                                                                                                                                                                                                                                                                                  Magistrate Judge

                                                                                                                                                                                                                                                                                                                  Judgment

(PLACE AN X IN ONE BOX ONLY)                                                                      basic of jurisdiction                                                  if diverity, indicate


 1 U.S. PLAINTIFF     
 
2 U.S. DEFENDANT            
 3 FEDERAL QUESTION          
 4 DIVERSITY                                                               CITIZENSHIP BELOW,

                                                                 U.S NOT A PARTY)                               (28 USC 1322, 1441)

CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY)

                (Place an [X] in one box for Plaintiff and one box for Defendant)

                                                                        PTF    DEF                                                                                       PTF    DEF                                                                                                         PTF    DEF

CITIZEN OF THIS STATE                      [ ]1      [ ]1            CITIZEN OR SUBJECT OF A                      [ ]3      [ ]3            INCORPORATED and PRINCIPAL PLACE         [ ]5      [ ]5

                                                                                                       FOREIGN COUNTRY                                                               OF BUSINESS IN ANOATHER STATE

CITIZEN OF ANOTHER STATE         [ ]2      [ ]2            INCORPORATED or PRINCIPAL           [ ]4      [ ]4            FOREIGN NATION                                                         [ ]6      [ ]6

                                                                                                      OF BUSINESS IN THIS STATE

 

PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES) (Calendar Rule 4(A))

Plaintiff's address

DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES) (Calendar Rule 4(A))

Defendant's address (if multiple defendants, use lead defendant's)

DEFENDANT(S) ADDRESS UNKNOWN

   REPRESNTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DILIGENCE, TO ASCERTAIN THE RESIDENCE ADDRESSES OF THE FOLLOWING DEFENDANTS:

 

Check one:         THIS ACTION SHOULD BE ASSIGNED TO:                              
 WHITE PLAINS             
 FOLEY SQUARE

                              (DO NOT check either box if this a PRISONERPETITION.)

DATE                                    SIGNATURE OF ATTORNEY OF RECORD                                                                ADMITTED TO PRACTICE IN THIS DISTRICT

                                                                                                                                                                                                      [ ] NO

                                                                                                                                                                                                      [ ] YES (DATE ADMITTED Mo. ________ Yr. _________)

RECEIPT                                                                                                                                                                                   Attorney Bar Code #

Magistrate Judge is to be designated by the Clerk of the Court.

Magistrate Judge                                                                                                                                     is so Designated.

James M. Parkison, Clerk of Court by _____________ Deputy Clerk, DATED _________________________.

UNITED STATES DISTRICT COURT (NEW YORK SOUTHERN)

 

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