JS 44 (Rev. 08/16)

CIVIL COVER SHEET

‘The 18 4 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
(SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM)

purpose of initiating the civil docket sheet.

Jnited States in September 1974, is required for the use of the Clerk of Court for the

1. (a) PLAINTIFFS
David Weir

(b) County of Residence of First Listed Plaintiff Montgomery _
(EXCEPT IN US. PLAINTIPE CASES)

o) Attorneys (Firm Name, Address, and Telephone Number)
erah E. Siemann
1015 E. Centerville Station Rd. Centerville OH 45459

DEFENDANTS
Randy Mount and Ram Restoration, LLC,

County of Residence of First Listed Defendant _Montgomery
(IN US. PLAINTIFF CASES ONLY)

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

NOTE

Attorneys (If Known)

IL. BASIS OF JURISDICTION (Pace an °X" in One Box Only) IH. CITIZENSHIP OF PRINCIPAL PARTIES (Pace an “x” in One Box for Plainnff
(For Diversity Cases Only) ‘and One Box for Defendant)
1 US. Government 2% 3 Federal Question PIF DE PTF DEF
Plaintiff? (US. Government Not a Party) Citizen of This State 1 1 1 Incorporated or Principal Place o4 04
‘of Business In This State
2 US. Government 4 Diversity Citizen of Another State 9 2 OF 2 Incorporated and Principal Place OS OS
(Indicate Citizenship of Parties in Hem Il) of Business In Another State
Citizen or Subject of a 03 © 3 Foreign Nation o6 96
Foreign Country
IV. NATURE OF SUIT (Place an “x” in One Box Only) Click here for: Nature of Suit Code Descriptions
CT TORTS FORFEITURE/PENALTY_
© 110 Insurance PERSONAL INJURY PERSONAL INJURY | 625 Drug Related Seizure | 422 Appeal 28USC 158 | © 375 False Claims Act
0 120 Marine 310 Airplane 1 365 Personal Injury ‘of Property 21 USC 881 | 423 Withdrawal 0 376 Qui Tam (31 USC
0 130 Miller Act 10315 Airplane Product Product Liability 0 690 Other 28 USC 157 3729(a))
© 140 Negotiable Instrument Liability © 367 Health Care: © 400 State Reapportionment
0 150 Recovery of Overpayment | [ 320 Assault, Libel & Pharmaceutical oO 410
& Enforcement of Judgment Slander Personal Injury 820 Copyrights 0 430 Banks and Banking
151 Medicare Act 0 330 Federal Employers’ Product Liability 1 830 Patent 8 450 Commerce
17 152 Recovery of Defaulted Liability 0 368 estos Personal 9 840 Trademark 9 460 Deportation
‘Student Loans. 340 Marine Injury Product 0 470 Racketeer Influenced and
(Excludes V ) (0-345 Marine Product Liability TABOR Corrupt Org:
(7 153 Recovery of Overpayment abil PERSONAL PROPERTY 710 Fair Labor Standards © 861 HIA (139Sff) 7 480 Consumer Credit
of Veteran's Benefits 0 350 Motor Vehicle © 370 Other id Act | 862 Black Lung (923) 0 490 Cable/Sat TV
1 160 Stockholders’ Suits 0 355 Motor Vehicle 0 371 Truth in Lending 9 720 Labor/Management 1 863 DIWC/DIWW (405(z)) | 1 850 Securities/Commoditi
1 190 Other Contract Product Liability 0 380 Other Personal Relations 3 864 SSID Title XVI Exchange
1 195 Contract Product Liability | 360 Other Personal Property Damage 0 740 Railway Labor Act 3 865 RSI(405(g)) 1 890 Other Statutory Actions
0 196 Franchise Injury 0 385 Property Damage 0 751 Family and Medical © 891 Agricultural Acts
19) 362 Personal Injury - Product Liability Leave Act 7 893 Environmental Matters
Medical Mi ice | 790 Other Labor Litigation 0895 Freedom of Information
REAL PROPERTY CIVIL RIGHTS: PRISONER PETITIONS | 791 Employee Retirement FEDERAL TAX SUITS | Act
© 210 Land Condemnation F 440 Other Civil Rights Habeas Corpus: Income Security Act 1 870 Taxes (U.S. Plaintiff 0 89% Arbitration
0 220 Foreclosure (0 441 Voting 0 463 Alien Detainee or Defendant) 0 899 Administrative Procedure
0 230 Rent Lease & Ejectme 0 442 Employment 0 510 Motions to Vacate 0 871 IRS—Third Party Act/Review or Appeal of
0 240 Torts to Land 0-443 Housing/ Sentence 26 USC 7609 Ageney Decision
0 245 Tort Product Liability Accommodations © 530 General 1 950 Constitutionality of
1 290 All Other Real Property 0-445 Amer. wid 1 535 Death Penalty TMMIGRATION_ State Statutes
Employme Other: EF 462 Naturalization Application
7 446 Amer. w/Disabi 7 540 Mandamus & Other] 465 Other Immigration
Other 0 550 Civil Rights Actions
19) 448 Education 1 555 Prison Condition
1 560 Civil Detainee -
Confinement

V. ORIGIN (Pace an “x” in One Box Only)

PAL Original 1.2 Removed from
Proceeding State Court

J 3  Remanded from

Appellate Court

0 4 Reinstated or

8 Multidistrict
Litigation -
Direct File

11 6 Multidistriet
Litigation -
Transfer

© 5 Transferred from
Another District
ispecity)

Reopened

29 USC 216

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

VI. CAUSE OF ACTION

Brief description of cause

Non-Payment of Wages, FLSA, Breach of Contract, and Constructive Discharge

VII. REQUESTED INO) GHECKIPTHISISA CLASSACTION DEMANDS CHECK YES only if demanded in complaint
COMPLAINT: UNDER RULE 23, F.R.Cy.P. 50,000.00 JURY DEMAND: 4 Yes No
VIII. RELATED CASE(S)
7 (See structions
IF ANY ete" JUDGE DOCKET NUMBER

DATE

CDE F RRCORD

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPINANG-

Cc

JUDGE MAG. JUDGE