2JS 44 (Rev. 12/07) 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. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM.)

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) (IN U.S. PLAINTIFF CASES ONLY)

NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE

 LAND INVOLVED.

(c) Attorney’s (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) 

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

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

of Business In This State

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

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

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

 Foreign Country

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

CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES

u 110 Insurance PERSONAL INJURY PERSONAL INJURY u 610 Agriculture u 422 Appeal 28 USC 158 u 400 State Reapportionment

u 120 Marine u 310 Airplane u 362 Personal Injury - u 620 Other Food & Drug u 423 Withdrawal u 410 Antitrust

u 130 Miller Act u 315 Airplane Product Med. Malpractice u 625 Drug Related Seizure 28 USC 157 u 430 Banks and Banking

u 140 Negotiable Instrument Liability u 365 Personal Injury - of Property 21 USC 881 u 450 Commerce

u 150 Recovery of Overpayment u 320 Assault, Libel & Product Liability u 630 Liquor Laws PROPERTY RIGHTS u 460 Deportation

 & Enforcement of Judgment Slander u 368 Asbestos Personal u 640 R.R. & Truck u 820 Copyrights u 470 Racketeer Influenced and

u 151 Medicare Act u 330 Federal Employers’ Injury Product u 650 Airline Regs. u 830 Patent Corrupt Organizations

u 152 Recovery of Defaulted Liability Liability u 660 Occupational u 840 Trademark u 480 Consumer Credit

 Student Loans u 340 Marine PERSONAL PROPERTY Safety/Health u 490 Cable/Sat TV

 (Excl. Veterans) u 345 Marine Product u 370 Other Fraud u 690 Other u 810 Selective Service

u 153 Recovery of Overpayment Liability u 371 Truth in Lending LABOR SOCIAL SECURITY u 850 Securities/Commodities/

 of Veteran’s Benefits u 350 Motor Vehicle u 380 Other Personal u 710 Fair Labor Standards u 861 HIA (1395ff) Exchange

u 160 Stockholders’ Suits u 355 Motor Vehicle Property Damage Act u 862 Black Lung (923) u 875 Customer Challenge

u 190 Other Contract Product Liability u 385 Property Damage u 720 Labor/Mgmt. Relations u 863 DIWC/DIWW (405(g)) 12 USC 3410

u 195 Contract Product Liability u 360 Other Personal Product Liability u 730 Labor/Mgmt.Reporting u 864 SSID Title XVI u 890 Other Statutory Actions

u 196 Franchise Injury & Disclosure Act u 865 RSI (405(g)) u 891 Agricultural Acts

 REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS u 740 Railway Labor Act FEDERAL TAX SUITS u 892 Economic Stabilization Act

u 210 Land Condemnation u 441 Voting u 510 Motions to Vacate u 790 Other Labor Litigation u 870 Taxes (U.S. Plaintiff u 893 Environmental Matters

u 220 Foreclosure u 442 Employment Sentence u 791 Empl. Ret. Inc. or Defendant) u 894 Energy Allocation Act

u 230 Rent Lease & Ejectment u 443 Housing/ Habeas Corpus: Security Act u 871 IRS—Third Party u 895 Freedom of Information

u 240 Torts to Land Accommodations u 530 General 26 USC 7609 Act

u 245 Tort Product Liability u 444 Welfare u 535 Death Penalty IMMIGRATION u 900Appeal of Fee Determination

u 290 All Other Real Property u 445 Amer. w/Disabilities - u 540 Mandamus & Other u 462 Naturalization Application Under Equal Access

Employment u 550 Civil Rights u 463 Habeas Corpus - to Justice

u 446 Amer. w/Disabilities - u 555 Prison Condition Alien Detainee u 950 Constitutionality of

Other u 465 Other Immigration State Statutes

u 440 Other Civil Rights Actions

V. ORIGIN

Transferred from

another district

(specify)

Appeal to District

Judge from

Magistrate

Judgment

 (Place an “X” in One Box Only)

u 1 Original

Proceeding

u 2 Removed from

State Court

u 3 Remanded from

Appellate Court

u 4 Reinstated or

Reopened

u 5 u 6 Multidistrict

Litigation

u 7

VI. CAUSE OF ACTION

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

Brief description of cause:

VII. REQUESTED IN

 COMPLAINT:

u CHECK IF THIS IS A CLASS ACTION

UNDER F.R.C.P. 23

DEMAND $ CHECK YES only if demanded in complaint:

JURY DEMAND: u Yes u No

VIII. RELATED CASE(S)

 IF ANY (See instructions): JUDGE DOCKET NUMBER

DATE SIGNATURE OF ATTORNEY OF RECORD

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE

Angela Swartz and Teddy Swartz

Gallia County, OH

Debra Nelson, The Nelson Law Firm

4357 Ferguson Drive #280, Cincinnati, OH 45254

304-736-7400

E.I. DU PONT DE NEMOURS AND COMPANY and THE

CHEMOURS COMPANY

Aaron T. Brogdon

SQUIRE SANDERS LLP

200 Huntington Center, 41 South High Street, Columbus, OH 43215

28 U.S.C.A § 1332

Personal Injury

Edmund A. Sargus 2:13-md-2433

02/20/2018 /s/ Debra Nelson

Case: 2:18-cv-00136-EAS-EPD Doc #: 1-1 Filed: 02/20/18 Page: 1 of 1 PAGEID #: 18