JS 44 (R~v. 09/11) 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 mitiating tlie civil docket sheet. (SEE /NSI'RUCTIONS ON NEX'I' p AGE OF THIS FORM) 

(b) County of Residence of First Listed Plaintiff 

(EXCEPT IN U.S. PLAINTIFF CASES) 

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

.DEFENDANTS £.<\Mt\'\i'- -\)Un\~\\-, I(, t>dh"\ .S("l\l-., JC)\\ 

(-{'; S\<'.,V-t.- <'!:-hv\1tA , ·e; 

County of Residence of First Listed Defendant 

(IN U.S. PLAINTIFF CASES ONLY) 

NOTE: INLAND CONDEMNATION CASES, USE 'IHE LOCATION OF 

TIIE 1RACT OF LAND INVOLVED. 

Attorneys (If Known) 

II. BASIS OF JURISDICTION (Pl"'"" "X" ;, Dao Box Only) ID. CITIZENSHIP OF PRINCIPAL PARTIES (Pia" on "X" ;, an, Box/a' Pla;m;JJ) 

0 1 U.S. Government 

Plaintiff 

02 U.S. Government 

Defendant 

'"tf\ 3 Federal Question 

(US. Govemmenl Not a Party) 

04 Diversity 

(Indicate Citizenship of Parties in Item Ill) 

IV NATURE OF SUIT (Place an "X'' in One Box Only) 

f;-. • :. - .+ COl\.'TRACT:-" i_?:,"1.. ;::-~:_ [·:.'. :1;"',.,:.-i;~"'°'"b"i-!.~:;',. TORTS-«·.-:_·,.-.·~_,'..2-~~:-".--~{1',.J:O'°h.;.-;1 · 

0 l JO Insurance PERSONAL INJURY PERSONAL INJURY 

0 120 Marine 0 310 Airplane 0 365 Personal Injury -

0 130 Miller Act 0 315 Airplane Product Product Liability 

0 l40Negotiablelnstrument Liability a 367 Health Carel 

0 150 Recovery ofOverpayment 0 320 Assault, Libel & Pharmaceutical 

& Enforcement of Judgment Slander Personal Injury 

0 151MedicareAct 0 330 Federal Employers' Product Liability 

0 152 Recovery ofDefaulted Liability a 368 Asbestos Personal 

Student Loans 0 340 ?\farfoe Injury Product 

{Exel. Veterans) 0 345 Marine Product Liability 

0 153 Recovery of Overpayment Liability PERSONAL PROPERTY 

ofVeteran's Benefits 0 350 Motor Vehicle 0 370 Other Fraud 

0 160 Stockholders' Suits 0 355 Motor Vehicle 0 371 Truth in Lending 

0 1900therContract Product Liability 0 380 Other Personal 

0 195 Contract Product Liability 0 360 Other Personal Property Damage 

0 196 Franchise Injury a 385 Property Damage 

O 362 Pe.n:onal Injury - Product Liability 

Med. M.alpraclire 

111--h-}g--'3' REAIJPROP.ER'I1Y f»')''g:: ,.;,-,~'.8MURIGHT-S l.il\';. -;.· ;PRISONER-PETITIONS;;.. 

0 210 Land Condemnation ~ 440 Other Civil Rights a 510 Motions to Vacate 

0 220 Foreclosure 0 441 Voting Sentence 

0 ·230 Rent Lease & Ejectment 0 442 Employment Habeas Corpus: 

0 240 Torts to Land 0 443 Housing/ 0 530 General 

0 245 Tort Product Liability Accommodations 0 535 Death Penalty 

0 290 All Olher Real Property 0 445 Amer. w/Disabilities - a 540 Mandamus & Other 

Employment a 550 Civil Rights 

0 446 Amer. w/Disabilities - a 555 Prison Condition 

Other 0 560 Civil Detainee -

0 448 Education Conditions of 

Confinement 

(Far Dfver.sltyCa.se.s Only) and One Box far Defendant) 

PfF .!J_FF

1 

PTF DEF 

Citizen of This State ):!i.,. I R Incorporated or Principal Place 0 4 0 4 

ofBusiness In This State 

Citizen of Another State a 2 a 2 Incorporated and Principal Place a 5 0 5 

ofBusiness In Another State 

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

Forei Coun 

~;; FORFEITUREJPENAI:.TY:::-· ~-~;__ ·.::c.- DA1''KRUPTCY\:: ·,, .. ·--,:.-OTHER STATUTES,.;':•"., .I ·-

0 625 Drug Related Seizure 0 422 Appeal 28 USC 158 0 375 False Claims Act 

of Property 2.1 USC 881 0 423 Withdrawal 0 400 State Reapportionment 

0 690 Other 28 use 151 0 410 Antitrust 

0 430 Banks and Banking 

W:c:PROPERTY-RTGHTSt-.r-E··; a 450 Commerce 

0 820 Copyrights 0 460 Deportation 

0 830Patent 0 470 Racketeer Influenced and 

0 840 Trademark Corrupt Organizations 

0 480 Consumer Credit 

r-"'~"'W.~t.-,.';;i-UAB ;::d.;:;.;.,>~c..--': ' . .,_. ·TAL.!.:E RTTY'-"''°"~"'' a 490 Cable/Sat TV 

0 710 Fair Labor Standards 0 861 HIA (l395ff) a 850 Securities/Commodities/ 

Ao< 0 862 Black Lung (923) Exchange 

0 720 Labor/M'gmt Relations 0 863 DIWC/DfWW (405(g)) a 890 Other Statutory Actions 

0 740 Railway Labor Act 0 864 SSID Title XVI a 891 Agricultural Acts 

0 751 FanulyandMedical 0 865 RS! {405(g)) 0 893 Environmental Matters 

Leave Act a 895 Freedom oflnformation 

0 790 Other Labor Litigation Aot 

0 791 Empl. Ret. Inc. 0 896 Arbitration 

Seeurity Act -!:..-;;,·FEDERALTAX-SUITS'"·:·,,- 0 899 Administrative Procedure 

0 870 Taxes (U.S. Plaintiff Act/Review or Appeal of 

or Defendant) Agency Decision 

0 871 IRS-Third Party 0 950 Constitutionalityof 

26 USC7609 State Statutes 

~kir:2.-Bi.~Thfl\.IIGRATION~& 

0 462 Naturalization Application 

0 463 Habeas Corpus -

Alien Detainee 

(Prisoner Petition) 

0 465 Other Immigration 

Actions 

V,". ORIGIN 

~1 Original 

Proceeding 

(Place an "X" in One Box Only) 

0 2 Removed from 0 3 Remanded from 0 4 Reinstated or O 5 Transferred from 

State Court Appellate Court Reopened asn~~er district 

0 6 Multidistrict 

Litigation 

VI. CAUSE OF ACTION Briefdescriptionofcause: 

VII. REQUESTED IN 

COMPLAINT: 

VIII. RELATED CASE(S) 

IF ANY 

DATE 

FOR OFFICE USE ONLY 

0 CHECK JF TIJIS IS A CLASS CTION 

UNDERF.RC.P. 23 

(See instructions): JUDGE 

SIGNAWREOF ATTORNEY OF RECORD 

RECEIPT# AMOUNT APPL YING IFP 

DOCKET NUMBER 

JUDGB -MAG.JUDGE 

Fonn39.030 

Case 2:15-cv-00419-PK Document 2-1 Filed 03/13/15 Page 1 of 1