JS 44 (Rev. 09/11) 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. 

I. (a) PLAINTIFFS DEFENDANTS

(b) County of Residence of First Listed Plaintiff County of Residence of First Listed Defendant

(EXCEPT IN U.S. PLAINTIFF CASES) NOTE: In land condemnation cases, use the location of the tract of land involved.

(c) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known)

II. BASIS OF JURISDICTION (Place an “X” in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X” in One Box for Plaintiff)

(For Diversity Cases Only) and One Box for Defendant) 

1 U.S. Government 3Federal Question PTF DEF PTF DEF

Plaintiff (U.S. Government Not a Party) Citizen of This State 1 1 Incorporated or Principal Place 4 4

of Business In This State

2 U.S. Government 4 Diversity Citizen of Another State 2 2 Incorporated and Principal Place 5 5

Defendant (Indicate Citizenship of Parties in Item III) of Business In Another State

Citizen or Subject of a 3 3 Foreign Nation 6 6

 Foreign Country

IV. NATURE OF SUIT (Place an “X” in One Box Only)

CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES

110 Insurance PERSONAL INJURY PERSONAL INJURY 625 Drug Related Seizure 422 Appeal 28 USC 158 375 False Claims Act

120 Marine 310 Airplane 365 Personal Injury - of Property 21 USC 881 423 Withdrawal 400 State Reapportionment

130 Miller Act 315 Airplane Product Product Liability 690 Other 28 USC 157 410 Antitrust

140 Negotiable Instrument Liability 367 Health Care/ 430 Banks and Banking

150 Recovery of Overpayment 320 Assault, Libel & Pharmaceutical PROPERTY RIGHTS 450 Commerce

 & Enforcement of Judgment Slander Personal Injury 820 Copyrights 460 Deportation

151 Medicare Act 330 Federal Employers’ Product Liability 830 Patent 470 Racketeer Influenced and

152 Recovery of Defaulted Liability 368 Asbestos Personal 840 Trademark Corrupt Organizations

 Student Loans 340 Marine Injury Product 480 Consumer Credit

 (Excl. Veterans) 345 Marine Product Liability LABOR SOCIAL SECURITY 490 Cable/Sat TV

153 Recovery of Overpayment Liability PERSONAL PROPERTY 710 Fair Labor Standards 861 HIA (1395ff) 850 Securities/Commodities/

 of Veteran’s Benefits 350 Motor Vehicle 370 Other Fraud Act 862 Black Lung (923) Exchange

160 Stockholders’ Suits 355 Motor Vehicle 371 Truth in Lending 720 Labor/Mgmt. Relations 863 DIWC/DIWW (405(g)) 890 Other Statutory Actions

190 Other Contract Product Liability 380 Other Personal 740 Railway Labor Act 864 SSID Title XVI 891 Agricultural Acts

195 Contract Product Liability 360 Other Personal Property Damage 751 Family and Medical 865 RSI (405(g)) 893 Environmental Matters

196 Franchise Injury 385 Property Damage Leave Act 895 Freedom of Information

362 Personal Injury - Product Liability 790 Other Labor Litigation Act

 Med. Malpractice 791 Empl. Ret. Inc. 896 Arbitration

 REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS Security Act FEDERAL TAX SUITS 899 Administrative Procedure

210 Land Condemnation 440 Other Civil Rights 510 Motions to Vacate 870 Taxes (U.S. Plaintiff Act/Review or Appeal of 

220 Foreclosure 441 Voting Sentence or Defendant) Agency Decision

230 Rent Lease & Ejectment 442 Employment Habeas Corpus: 871 IRS—Third Party 950 Constitutionality of

240 Torts to Land 443 Housing/ 530 General 26 USC 7609 State Statutes

245 Tort Product Liability Accommodations 535 Death Penalty IMMIGRATION

290 All Other Real Property 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)

448 Education Conditions of 465 Other Immigration

 Confinement Actions

V. ORIGIN Transferred from

another district

(specify)

 (Place an “X” in One Box Only)

1 Original

Proceeding

2 Removed from

State Court

 3 Remanded from

Appellate Court

4 Reinstated or

Reopened

 5 6 Multidistrict

Litigation

VI. CAUSE OF ACTION (Enter U.S. Civil Statute under which you are filing and 

 write a brief statement of cause.)

VII. PREVIOUS BANKRUPTCY MATTERS (For nature of suit 422 and

423, enter the case number and judge for any associated bankruptcy matter previously

adjudicated by a judge of this Court. Use a separate attachment if necessary.)

VIII. REQUESTED IN

 COMPLAINT:

CHECK IF THIS IS A CLASS ACTION

UNDER F.R.C.P. 23

DEMAND $ CHECK YES only if demanded in complaint:

JURY DEMAND: Yes No

IX. This case (check one box) is not a refiling of a previously dismissed action

 is a refiling of case number ______________ previously dismissed by Judge ___________________

Date Signature of Attorney of Record

Case: 1:11-cv-07814 Document #: 4 Filed: 11/03/11 Page 1 of 1 PageID #:23