rs a4 ~Re~ ~z~~z, CIVIL COVER SHEET

The 7S 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_ (.SEGlNS~RUC'/'IONS ON NLY7 PAGE OF THIS FORM.)

I. (a) PLAINTIFFS

Matteo Brunozzi

(b) County of Residence of First Listed Plaintiff Multnomah County OR

(RXCF,P7'INU.S. P/AINTIFFCAS6SJ

DEFENDANTS

Cable Communications, Inc.

County of Residence of First Listed Defendant Lowndes County, GA

(IN U.S. PLAlN17FF CASTS ONLY)

NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF

THE TRACT OF LAND LNVOLVED,

~C~ Aftol'RCyS (h'rrm Name, Address, and "telephone Number)

Leslie E. Blaze, Schuck Law, LLC

10013 NE Hazel Dell Avenue, #178

Vancouver, WA 98685; (360) 566-9243

AttornOyS (f Known)

Mitchell C. Baker

Laura P. Jordan

II. BASIS OF JURISDICTION (Place an "x" in one e~x only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an "x"~n one aox,~or Y[a~nr ff

(For Diver.riry Cares Only) and One Box,for DejendantJ

O 1 U,S. Government c~ 3 Federal Question PTF DF,F PTF DEF

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

of Business 1~~ This Stace

O 2 U.S. Govermnent O 4 Diversity Citizen of Another State O 2 O 2 Inco~yorated and Principal Place O 5 O 5

Defendant (/ndlca~e Citizenship of Parries in /tem III) o£Business In Another Stale

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

Forei ~n Coun

IV_ NATi1RF nF SiiiTrnr~~P~„ ~~x~~;,,nnPR„rn~~„~

c~on~~rkncr roirrs r~oiir~~rruiiH.m~~:~~~ry e:a.~~h~iuPici~ arHrais~rxru~re5

O 1 ]0 Insurance PERSONAL INJURY PERSONAL INJURY O 625 Drug Related Seizure O 422 Appea128 USC 158 O 375 False Claims Act

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

O t30 Miller .Act O 315 Airplane Produc[ Product Liability O 690 Other 28 USC 157 O 410 Mtitrust

O 140 Negotiable Instrument Liability O 367 Health Care/ O 430 Batilcs and Banking

O I50 Recovery of Overpayment D 320 Assault, Libel & Pharmaceutical YI20PERT1' RIGHTS O 450 Commerce

& Enforcement ofJudgment Slander Personal Injury O 820 Copyrights O 460 Deportation

O I ~ I Medicare Act O 330 Federal Employers' Product Liability O 830 Patent O 470 Racketeer Influenced and

O 1 ~2 Recovery of Defaulted Liability O 368 Asbestos Personal O 840 Trademark Corrupt Organizations

Student Loans O 340 Marine Injury Product O 480 Consmner Credit

(Excludes Veterans) O 345 Marine Product Liability LA[fOK SOCIAL SRCI~RITI' O 490 Cable/Sat TV

O 153 Recovery of Overpayment Liability PERSONAL PROPERTY ~ 710 Fair Labor Standards O 86 I HIA (13v5fY) O 850 Securities/Commodiries/

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

O 160 Stockholders' Suits O 355 Motor Vehicle O 37J Truth iu Leodiug O 720 Labor/Management O 863 DIWCJDIWW (405(g)) O 890 Other Statutory Ac4ons

O 190 Other Contract Product Liability O 380 Other Personal Relations O 864 SSID Title XVI O 891 Agricultural Acts

O 195 Contract Product Liability O 360 Other Personal Property Damage O 740 Railway Labor Act O 865 RSI (405(8)) O 893 Environmental Matters

O 196 Franchise Injury O 385 Propert}~ Damage O 751 Family and Medical O 895 Freedom of Information

O 362 Personal Injury - Product Liability Leave Act Act

Medical Mal ractice O 790 Other Labor Litibation

O 79l Employee Retirement

Income Security Act

O 896 Arbitration

O 899 Administrative Procedure

AcdReview or Appeal of

R6;AL PNOPN:H'Tl' CIVI1. RIGIITS PRISONF,R NETITIOVS '` FEDENAL TA)i SCI'I'S

O 2l0 Land Condemnation O 440 Other Civil Rights Habeas Corpus: O 870 Taxes (U.S. Plaintiff

O 220 Foreclosure O 441 Voting O 463 Alien Detainee or Defendant) Agency Decision

O 230 Rent Lease & Ejechnen[ O 442 Employment O 510 Motions to Vacate O 871 IRS—Third Party O 950 Constitutionality of

O 240 Tons to Land O 443 Housing/ Sentence 26 USC 7609 State Statutes

O 245 Tort Product Liability Accommodations O 530 General

O 290 All Other Real Property O 445 Amer. w/Disabilities - O 535 Death Penalty I~1M1iIGIL~7'IOV

Employment Other; ❑ 462 Naturalization Application

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

Other O 550 Cwil Rights Actions

O 448 Education O 555 Prison Condition

O 560 Civil Detainee -

Conditions of

Confinement

V. ~R1Ci1N (Place an "X" in One Box Only)

O I Original ~ 2 Removed from O 3 Remanded from O 4 Reinstated or O 5 Transferred from O 6 Multidistrict

Proceeding State Court Appellate Court Reopened Another District Litigation

(snecifvl

Cite the U S. Civil Statute Under which you are filmg (Uri not citejurisdictiona[statules unless ~/iversityJ:

VI. CAUSE OF ACTION 

2$ U.S.C. Sections 1331, 1332, 1441, and 1446

Brief description of cause,

Alleged violation of the Fair Labor Standards Act of 1938, 29 U.S.C. Sections 201-219, Wage Claim Retaliation

VII. REQUESTED IN ~ CHECK IF THIS IS A CLASS ACTION DEMAND $ CHECK YES only if demanded in complaint:

COMPLAINT: UNDER RULE 23, F.R.Cv,P. 999,999.00 JURY DEMAND: ~ Yes O No

VIII. RELATED CASES)

lF ANY 

(See Instructions): 

JUDGE DOCKET NUMBER

DATE SIGNATURE OF F~ AT RNTO ~F uFCORD

~- I ~ 2v ~ y ~ ~~

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. IUDGE