EXHIBIT “5”
JS 44 (Rev. 06/17) 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. (.,EE INSTIIUC110NS ON NEXT PAGE OF 1HIS FORM.) 

I. (a) PLAINTIFFS 

Kendra Coufal 

(b) County of Residence of First Listed Plaintiff Bell County, Texas 

(EXCEPT IN US. PLAINTIFF CASES) 

( C) Attorneys (Firm Name, Address, and Telephone Number) 

Jennifer L. Mathis 

Daniel Stark, P.C. 

PO Box 1153 

Bryan, TX 77806 

979-756-8686 

DEFENDANTS 

Roger Lee Thomas and Apple Logistics, Inc. 

County of Residence of First Listed Defendant Caddo County, Louisiana 

(IN US. PLAINTIFF CASES ONLY) 

NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE TRACT OF LAND INVOLVED. 

Attorneys (I/Known) 

Davidl.Sargent 

Sargent law, P .C. 

1717 Main, Sulle4750 

Dallas, Texas 75201 

214-749-600 

II. BASIS OF JURISDICTION (Place an "X" in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an "X" in One Boxjor Plaint/ff 

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

11 1 U.S. Government 11 3 Federal Question PTF DEF PTF DEF 

Plaintiff (U.S. Government Not a Party) Citizen of This State l'X 1 0 1 lnco11iorated or Principal Place O 4 11 4 

of Business In This State 

11 2 U.S. Government ~4 Diversity Citizen of Another State 11 2 1X 2 Incoqmrated and Principal Place 11 5 0 5 

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

Citizen or Subject of a 0 3 0 3 Foreign Nation 0 6 0 6 

Forei 1 11 Countt 

IV NATURE OF SUIT (Place an "X" in One Box OnM CIC r k here or: Nature of S Ult Cd o e Descrmttons. I CONTRACT . .. ... · • TORTS ·:· '<'•• ··>·•·< ·.;>•<.'·. ·.·FORFEITURE/PENALTY < •·:. •BANKRUPTCY ···,. OTHER STATUTES 

0 110 Insurance PERSONAL INJURY PERSONAL INJURY 0 625 Drug Related Seizure 0 422 Appeal 28 USC 158 0 375 False Claims Act 

11 120 Marine 11 310 Airplane 0 365 Personal lnjllly • of Prope11y 21 USC 881 11 423 Withdrawal 11 3 76 Qui Tam (31 USC 

0 130 Miller Act 0 315 Airplane Product Product Liability 0 690 Other 28 USC 157 3729(a)) 

0 140 Negotiable Instrument Liability 0 367 Health Care/ 0 400 State Reapportionment 

0 150 Recove1y of Overpayment 0 320 Assault, Libel & Phannaceutical PR:OPERTYRIGI-ITS 11 410 Antitrust 

& Enforcement of Judgment Slander Personal Injmy 0 820 Copyrights 0 430 Banks and Banking 

0 151 Medicare Act 0 330 Federal Employers' Product Liability 0 830 Patent 0 450 Commerce 

0 152 Recove1y of Defaulted Liability 0 368 Asbestos Personal 0 835 Patent - Abb1cviated 0 460 Deportation 

Student Loans 0 340 Marine lnjmy Product New Drug Application 0 470 Racketeer Influenced and 

(Excludes Veterans) 0 345 Marine Product Liability 0 840 Trademark Corrupt Organizations 

0 153 Recove1y of Oveq,ayment Liability PERSONAL PROPERTY LABOR .. s, 11 IAI SECURITY 0 480 Consumer Credit 

of Veteran's Benefits ~ 350 Motor Vehicle 0 370 Other Fraud 0 710 Fair Labor Standards 0 861 HIA (1395ft) 0 490 Cable/Sat TV 

0 160 Stockholders' Suits !1 355 Motor Vehicle 11 371 Truth in Lending Act l1 862 Black Lung (923) 11 850 Securities/Commodities/ 

0 190 Other Contract Product Liability 0 380 Other Personal 0 720 Labor/Management 0 863 DIWC/DIWW (405(g)) Exchange 

0 195 Contract Product Liability 0 360 Other Personal Property Damage Relations 0 864 SSID Title XVI 0 890 Other Statuto,y Actions 

0 196 Franchise lnjllly 0 385 Property Damage 0 740 Railway Labor Act 0 865 RSI (405(g)) 0 891 Agricultural Acts 

0 362 Personal htjllly - Product Liability 0 751 Family and Medical 0 893 Environmental Matters 

Medical Mahiracrice Leave Act 0 895 Freedom oflnfonnation 

I REAL PROPERTY . CIVIL RlGHTS PRISONER PETITIONS 11 790 Other Labor Litigation • FEDERAL TAX SUITS Act 

0 2 IO Land Condemnation 0 440 Other Civil Rights Habeas Corpus: 0 791 Employee Retirement 0 870 Taxes (U.S. Plaintiff 0 896 Arbitration 

0 220 Foreclosure 0 441 Voting 0 463 Alien Detainee Income Security Act or Defendant) 0 899 Administrative Procedure 

0 230 Rent Lease & Ejectment 0 442 Employment 0 510 Motions to Vacate 0 871 IRS-ThirdParty Act/Review or Appeal of 

11 240 Torts to Land 11 443 Housing/ Sentence 26 use 7609 Agency Decision 

0 245 Tort Product Liability Accommodations 0 530 General 0 950 Constitutionality of 

0 290 All Other Real Property 0 445 Amer. w/Disabilities - 0 535 Death Penalty ; IMMlGRATION •. State Statutes 

Employment Other: 0 462 Naturalization Application 

0 446 Amer. w/Disabilities - 11 540 Mandamus & Other 0 465 Other Immigration 

Other 0 550 Civil Rights Actions 

!1 448 Education 0 555 Prison Condition 

0 560 Civil Detainee -

Conditions of 

Confinement 

V. ORIGIN (Place an "X" in One Box Only) 

0 I Original ~2 Removed from 

Proceeding State Court 

0 3 Remanded from 

Appellate Court 

0 4 Reinstated or Reopened 

0 5 Transferred from 

Another District 

(,pec/fy) 

0 6 Multidistrict 

Litigation - Transfer 

Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity): 

0 8 Multidistrict 

Litigation - Direct File 

I 

VI. CA USE OF ACTION 1--'='D-'-"iv..:::e.:..,rs'-"it'-'--"u""'n"'"d.:a:.er'--'s,,,,e.,_.,c'-"ti.:a:.o!.!.n ...,_1""'3""'32=-i-1,_4'-'4...,_1..1..:b::..u.;a:a:.:n-=-'d"-'-14.:....4-'-'6'-o"'f....,t!.!.he"'--"U'-'-'nc.:.it""ed:a:....:::S..:ota::.:.te"'s"-"'C-"'-od"'"e"'. _____________ _ Brief description of cause: 

VII. REQUESTED IN 

COMPLAINT: 

VIII. RELATED CASE(S) 

IF ANY 

DATE 

04/30/2020 

This cause of action arises out of a motor vehicle collision, and is removed to this Court based on diversit 

0 CHECK IF THIS IS A CLASS ACTION DEMAND$ CHECK YES only if demanded in complaint: 

UNDER RULE 23, F.R.Cv.P. 1,000,000.00 JURY DEMAND: 0 Yes )(!No 

(.\'ee instructiom): 

DOCKET NUMBER 

FOR OFFICE lJSE ONLY 

RECEIPT// AMOUNT APPL YING IFP JUDGE MAG. JUDGE