DPR MODIFIED PROMESA B1040 (FORM 1040) (05/17) 

PROMESA COVER SHEET 

(Instructions on Reverse) 

CASE NUMBER 

(Court Use Only) 

PLAINTIFFS (DEBTOR, if Title III Petition;

ISSUER, if Title VI Application)

DEFENDANTS

ATTORNEYS (Firm Name, Address, and Telephone 

No.)

ATTORNEYS (If Known)

PARTY (Check One Box Only)

 t Debtor 

 t Creditor 

 t Trustee 

 t U.S. Trustee/Bankruptcy Admin 

 t Other 

PARTY (Check One Box Only)

 t Debtor 

 t Creditor 

 t Trustee 

 t U.S. Trustee/Bankruptcy Admin 

 t Other 

CAUSE OF ACTION (WRITE A BRIEF STATEMENT OF CAUSE OF ACTION, INCLUDING ALL U.S. STATUTES INVOLVED) 

NATURE OF SUIT 

t PROMESA Title III Petition t PROMESA Title VI Application for Approval of Modifications 

t Other Federal Question t Adversary Proceeding t Demand $ __________ 

If Adversary Proceeding is checked, number up to five (5) boxes starting with lead cause of action as 1, first 

alternative cause as 2, second alternative cause as 3, etc., below:

FRBP 7001(1) – Recovery of Money/Property 

t 11-Recovery of money/property - §542 turnover of 

property 

t 12-Recovery of money/property - §547 preference 

t 13-Recovery of money/property - §548 fraudulent 

transfer 

t 14-Recovery of money/property – other 

FRBP 7001(2) - Validity, Priority or Extent of Lien 

t 21-Validity, priority or extent of lien or other interest 

in property 

FRBP 7001(5) – Revocation of Confirmation 

t 51-Revocation of confirmation 

FRBP 7001(7) – Injunctive Relief 

t 71-Injunctive relief - imposition of stay 

t 72-Injunctive relief - other 

FRBP 7001(8) Subordination of Claim or Interest 

t 81-Subordination of claim or interest 

FRBP 7001(9) Declaratory Judgment 

t 91-Declaratory judgment 

FRBP 7001(10) Determination of Removed Action 

t 01-Determination of removed claim or cause 

Other 

t 02-Other (e.g. other actions that would have been 

brought in state court if unrelated to bankruptcy case) 

TITLE III CASE IN WHICH THIS ADVERSARY PROCEEDING ARISES

NAME OF DEBTOR CASE NO. 

DISTRICT IN WHICH CASE IS PENDING DIVISION OFFICE NAME OF JUDGE 

FINANCIAL OVERSIGHT AND MANAGEMENT BOARD FOR PUERTO RICO;

JOSÉ B. CARRIÓN III; ANDREW G. BIGGS; CARLOS M. GARCÍA; ARTHUR

J. GONZÁLEZ; JOSÉ R. GONZALEZ; ANA J. MATOSANTOS; DAVID A.

SKEEL, JR.

ASSURED GUARANTY CORP.; ASSURED

GUARANTY MUNICIPAL CORP.

Hermann D. Bauer, O'NEILL & BORGES LLC

 250 Muñoz Rivera Ave., Suite 800, San Juan, PR 00918-1813

Tel.: (787) 764-8181 Email: hermann.bauer@oneillborges.com

Heriberto Burgos Pérez, CASELLAS ALCOVER & BURGOS P.S.C.

P.O. Box 364924, San Juan, PR 00936-4924

Tel.: (787) 756-1400 Email: hburgos@cabprlaw.com

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✔

Adversary Complaint for Declaratory Judgment and Injunctive Relief under the U.S.

Constitution and PROMESA (48 U.S.C. §§ 2101-2241)

✔

✔

✔

The Financial Oversight and Management Board for Puerto Rico as representative of the

Commonwealth of Puerto Rico and Puerto Rico Highways & Transportation Authority Nos. 17 BK 3283-LTS, 17 BK 3567-LTS

District of Puerto Rico Hon. Laura Taylor Swain

Case:17-03283-LTS Doc#:3674-5 Filed:07/23/18 Entered:07/23/18 15:58:25 Desc:

Exhibit PROMESA Cover Sheet Page 1 of 2
DPR MODIFIED PROMESA B1040 (FORM 1040) (05/17) 

RELATED ADVERSARY PROCEEDING (IF ANY)

PLAINTIFF DEFENDANT ADVERSARY 

PROCEEDING NO. 

DISTRICT IN WHICH CASE IS PENDING DIVISION OFFICE NAME OF JUDGE 

SIGNATURE OF ATTORNEY (OR PLAINTIFF) 

DATE PRINT NAME OF ATTORNEY (OR PLAINTIFF) 

THIS FORM IS TO BE USED EXCLUSIVELY FOR FILINGS RELATING TO THE PUERTO RICO OVERSIGHT MANAGEMENT AND ECONOMIC STABILITY 

ACT (PROMESA). FOR ADMINISTRATION PURPOSES ONLY, THE PUBLIC DOCKETS FOR PROMESA PROCEEDINGS UNDER TITLE III AND 

ADVERSARY PROCEEDINGS WILL BE MAINTAINED ON THE CASE MANAGEMENT/ELECTRONIC CASE FILING (CM/ECF) SYSTEM OF THE UNITED 

STATES BANKRUPTCY COURT FOR THE DISTRICT OF PUERTO RICO. THESE CASES ARE UNDER THE JURISDICTION OF THE UNITED STATES 

DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO. 

July 23, 2018 Heriberto Burgos Pérez

Case:17-03283-LTS Doc#:3674-5 Filed:07/23/18 Entered:07/23/18 15:58:25 Desc:

Exhibit PROMESA Cover Sheet Page 2 of 2