alea-institute/kl3m-data-sample-004-shuffled huggingface dataset:
Document

Exhibit 10.28


THIRD ADDENDUM TO STANDARD INDUSTRIAL/COMMERCIAL MULTI-TENANT LEASE – NET DATED JANUARY 13, 2012 BY AND BETWEEN RGS PROPERTIES, AS LESSOR AND EXAGEN DIAGNOSTICS, INC. AS LESSEE, FOR THE PREMISES LOCATED AT 1261 LIBERTY WAY, SUITE B AND C, CALIFORNIA.


Lessor and Lessee mutually agree to amend the lease as follows:


Paragraph 1.3 (Term):
The Lease Term will be extended to the new Expiration Date of January 31, 2021


Paragraph 50 (Rent Schedule):
Base Rent shall be as follows:


						
	Dates	Base Rent
	February 1, 2018 - January 31, 2019	$13,086.60 per month
	February 1, 2019 - January 31, 2020	$13,479.20 per month
	February 1, 2020 - January 31, 2021	$13,883.57 per month




HVAC repairs and maintenance:


Attached to this Addendum is Exhibit B1: HVAC Report by Gilmore Refrigeration, Inc. Within sixty (60) days of Lessee’s execution of this addendum, Lessor, at Lessor’s expense, shall complete the following items noted in Exhibit B1:


a.Complete the recommended repairs and any needed service on units 10 & 12.
b.Unit #13: Replace condenser motor, correction of the ducting so that recirculation ducting is installed and the supply and return is tied.
c.Unit #14: Replacement of condenser motor and servicing.
d.Unit #15: Replace pol contactor necessary to deliver power to the unit. Any additional repairs to Unit #15 shall be the responsibility of Lessee.


Lessee will be responsible for any other work or modifications to HVAC systems as determined by Lessee. Upon execution of this Addendum, Lessee shall be responsible for contracting direct with an HVAC vendor for maintenance and repairs and have full control over the HVAC systems.


Roof and Skylights:


Lessor will repair all roof leaks and replace skylights as needed. Lessor warrants the integrity of the roof through the term of the lease extension and will repair all roof leaks within sixty (60) days following Lessee’s execution of the lease extension.


Option to Extend:


Lessee shall have one (1), three (3) year option to extend per the attached exhibit (paragraph 61b).












All other terms and conditions of the existing Lease shall remain in full force and effect.








									
	LESSOR:	

	LESSEE:
	RGS Properties	

	Exagen Diagnostics, Inc.
	

	

	


	

	

	


	By: /s/ Greg Smith	

	By: /s/ Ron Rocca
	

	

	


	By:	

	Title: CEO
	

	

	


	Date: 6/16/2017	

	Date: 5/9/2017
## In The Court of Appeals Sixth Appellate District of Texas at Texarkana

No. 06

- 17

- 00035

- CR

ROBERT WILLIAM FRAZIER, Appellant

V. THE STATE OF TEXAS, Appellee

On Appeal from the 115th District Court Upshur County, Texas Trial Court No. 17542

Before Morriss, C.J., Moseley and Burgess, JJ.2 

### O R D E R Our review of the reporter’s record in this case indicates that it contains “sensitive d ata” as that phrase is defined in Rule 9.10 of the Texas Rules of Appellate Procedure. See T EX
. R. A PP
. P . 9.10(a). Sensitive data includes “a driver’s license number, passport number, social security number, tax identification number or similar government

- issued personal identification number.”
T EX
. R. A PP
. P . 9.10(a)(1). Volume seven of the reporter’s re cord includes appellant’s social security number. Rule 9.10(b) states, “Unless a court orders otherwise, an electronic or paper filing with the court, including the contents of any appendices, must not contain sensitive data.”
T EX
. R. A PP
. P . 9.10(b).
R ule 9.10(g) provides, “A court may also order that a document be filed under seal in paper form or electronic form, without redaction.” T EX
. R. A PP
. P. 9.10(g). Therefore, because volume seven of the reporter’s record contains sensitive data, we order th e clerk of this Court or her appointee, in accordance with Rule 9.10(g), to seal volume seven of the electronically filed reporter’s record in this case.
IT IS SO ORDERED.
BY THE COURT
Date: August 1, 2017
CERTIFICATION
PURSUANT TO


18 U.S.C.
SECTION 1350,


AS
ADOPTED PURSUANT TO


SECTION
906 OF THE SARBANES-OXLEY ACT OF 2002





In
connection with the Annual Report on Form 10-K of SheerVision, Inc. (the
“Company”) for the fiscal year ended August 31, 2009 filed with the
Securities and Exchange Commission (the “Report”), I, Suzanne Lewsadder, Chief
Executive Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350,
as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002,
that:





(1) The
Report fully complies with the requirements of Section 13(a) or 15(d) of the
Securities Exchange Act of 1934; and





(2) The
information contained in the Report fairly presents, in all material respects,
the consolidated financial condition of the Company as of the dates presented
and consolidated results of operations of the Company for the periods
presented.




Dated:
      December 15, 2009By:
                  /s/
      Suzanne LewsadderSuzanne
      LewsadderChief
      Executive Officer




This
certification has been furnished solely pursuant to Section 906 of the
Sarbanes-Oxley Act of 2002.





A signed
original of this written statement required by Section 906 has been provided to
SheerVision, Inc. and will be retained by SheerVision, Inc. and furnished to the
Securities and Exchange Commission or its staff upon request.
Case 1:07-cv-03382-HB     Document 5      Filed 06/29/2007     Page 1 of 3

Case 1:07-cv-03382-HB     Document 5      Filed 06/29/2007     Page 2 of 3

Case 1:07-cv-03382-HB     Document 5      Filed 06/29/2007     Page 3 of 3
September 12, 2013



### JUDGMENT 

## The Fourteenth Court of Appeals

JOHN EARL HALL , Appellant

NO. 14

- 13

- 00373

- CV V.

ELSIE MARTIN

- SIMON , Appellee

________________________________ Today the Court heard its own motion to dismiss the appeal from the judgment signed by the court below on April 15, 2013. Having considered the motion and found it meritorious, we order the appeal DISMISSED

. We further or der that all costs incurred by reason of this appeal be paid by appellant, John Earl Hall. We further order this decision certified below for observance.
<PAGE>


                                                                    Exhibit 32.1


                           CERTIFICATIONS PURSUANT TO
                             18 U.S.C. SECTION 1350
                             AS ADOPTED PURSUANT TO
                  SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002




In connection with the Second Quarter Report of The First Years, Inc. (the
"Company") on Form 10-Q for the period ended June 30, 2003, as filed with
Securities and Exchange Commission on the date hereof (the "Report"), I, Ronald
J. Sidman, Chief Executive of the Company, certify, pursuant to 18 U.S.C.
Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of
2002, that to the best of my knowledge:

     (1)  The Report fully complies with the requirements of section 13(a) or
          15(d) of the Securities Exchange Act of 1934; and

     (2)  The information contained in the Report fairly presents, in all
          material respects, the financial condition and results of operations
          of the Company.


Date:  August 14, 2003            By: /s/ RONALD J. SIDMAN
                                      Ronald J. Sidman, Chief Executive Officer
                                      Chairman of the Board of Directors,
                                      and President

A signed original of this written statement required by Section 906 has been
provided to The First Years Inc. and will be retained by The First Years Inc.
and furnished to the Securities and Exchange Commission or its staff upon
request.
THE THIRTEENTH COURT OF APPEALS

13-15-00324-CV

Tracey W. Murphy

v.

Christopher Pauley, et al.

On Appeal from the

343rd District Court of Bee County, Texas

Trial Cause No. B-14-1508-CV-C

JUDGMENT

THE THIRTEENTH COURT OF APPEALS, having considered this cause on 

appeal, concludes that the judgment of the trial court be affirmed. The Court orders the 

judgment of the trial court AFFIRMED. No costs are assessed as appellant filed an 

affidavit of inability to pay costs.

We further order this decision certified below for observance.

May 26, 2016
Michigan Supreme Court

Lansing, Michigan

Marilyn Kelly,

 Chief Justice

Michael F. Cavanagh

Elizabeth A. Weaver

Maura D. Corrigan

Robert P. Young, Jr.

Stephen J. Markman

Diane M. Hathaway, Justices

I, Corbin R. Davis, Clerk of the Michigan Supreme Court, certify that the 

foregoing is a true and complete copy of the order entered at the direction of the Court. 

 _________________________________________ 

 Clerk

April 16, 2010 

p0413 

Order 

 

April 16, 2010 

138805 

LORI CALDERON, as Guardian of ARTHUR 

KRUMM, a Legally Incapacitated Person, 

Plaintiff/Counter-DefendantAppellee, 

and SC: 138805 

 COA: 283313 

Wayne CC: 06-602100-NF 

FUNCTIONAL RECOVERY, INC., 

 Intervening Plaintiff/Appellee, 

v 

AUTO-OWNERS INSURANCE COMPANY, 

Defendant/Counter-PlaintiffAppellant. 

_________________________________________/ 

On order of the Court, the application for leave to appeal the March 24, 2009 

judgment of the Court of Appeals is considered. We direct the Clerk to schedule oral 

argument on whether to grant the application or take other peremptory action. MCR 

7.302(H)(1). The parties may file supplemental briefs within 42 days of the date of this 

order, but they should not submit mere restatements of their application papers.
#### TAYLOR v. JOHNSTON

No. 111 PC.

Case below: 27 N.C. App. 186.

Petition for discretionary review under G.S. 7A-31 allowed 17 December 1975.
[Federal Register Volume 72, Number 191 (Wednesday, October 3, 2007)]
[Notices]
[Page 56366]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-4863]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health


National Institute of Child Health and Human Development; Notice 
of Closed Meeting

    Pursuant to section 10(d) of the Federal Advisory Committee Act, as 
amended (5 U.S.C. Appendix 2), notice is hereby given of the following 
meeting.
    The meeting will be closed to the public in accordance with the 
provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 
U.S.C., as amended. The grant applications and the discussions could 
disclose confidential trade secrets or commercial property such as 
patentable material, and personal information concerning individuals 
associated with the grant applications, the disclosure of which would 
constitute a clearly unwarranted invasion of personal privacy.

    Name of Committee: National Institute of Child Health and Human 
Development Special Emphasis Panel; The Role of Human Milk-Morrow--
SEP.
    Date: October 19, 2007.
    Time: 2 p.m. to 4 p.m.
    Agenda: To review and evaluate grant applications.
    Place: Ramada Inn Rockville, 1775 Rockville Pike, Rockville, MD 
20852.
    Contact Person: Rita Anand, PhD, Scientific Review 
Administrator, Division of Scientific Review, National Institute of 
Child Health and Human Development, NIH, 6100 Executive Blvd., Room 
5B01, Bethesda, MD 20892, (301) 496-1487, <a href="/cdn-cgi/l/email-protection#e1808f808f8593a18c80888dcf8f8889cf868e97"><span class="__cf_email__" data-cfemail="43222d222d2731032e222a2f6d2d2a2b6d242c35">[email protected]</span></a>.
    This notice is being published less than 15 days prior to the 
meeting due to the timing limitations imposed by the review and 
funding cycle.

(Catalogue of Federal Domestic Assistance Program Nos. 93.864, 
Population Research; 93.865, Research for Mothers and Children; 
93.929, Center for Medical Rehabilitation Research; 93.209, 
Contraception and Infertility Loan Repayment Program, National 
Institutes of Health, HHS)

    Dated: September 25, 2007.
Jennifer Spaeth,
Director, Office of Federal Advisory Committee Policy.
[FR Doc. 07-4863 Filed 10-2-07; 8:45 am]
BILLING CODE 4140-01-M


</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>
<TABLE> <S> <C>

<ARTICLE> UT
<CIK> 0000055373
<NAME> KENTUCKY POWER COMPANY
<MULTIPLIER> 1,000
       
<S>                                        <C>
<PERIOD-TYPE>                              6-MOS
<FISCAL-YEAR-END>                          DEC-31-1996
<PERIOD-END>                               JUN-30-1997
<BOOK-VALUE>                                  PER-BOOK
<TOTAL-NET-UTILITY-PLANT>                      681,093
<OTHER-PROPERTY-AND-INVEST>                      6,376
<TOTAL-CURRENT-ASSETS>                          61,227
<TOTAL-DEFERRED-CHARGES>                         8,758
<OTHER-ASSETS>                                  88,789
<TOTAL-ASSETS>                                 846,243
<COMMON>                                        50,450
<CAPITAL-SURPLUS-PAID-IN>                      118,750
<RETAINED-EARNINGS>                             82,982
<TOTAL-COMMON-STOCKHOLDERS-EQ>                 252,182
<PREFERRED-MANDATORY>                                0
<PREFERRED>                                          0
<LONG-TERM-DEBT-NET>                           293,271
<SHORT-TERM-NOTES>                                   0
<LONG-TERM-NOTES-PAYABLE>                            0
<COMMERCIAL-PAPER-OBLIGATIONS>                  58,700
<LONG-TERM-DEBT-CURRENT-PORT>                        0
<PREFERRED-STOCK-CURRENT>                            0
<CAPITAL-LEASE-OBLIGATIONS>                     11,338
<LEASES-CURRENT>                                 3,280
<OTHER-ITEMS-CAPITAL-AND-LIAB>                 227,472
<TOT-CAPITALIZATION-AND-LIAB>                  846,243
<GROSS-OPERATING-REVENUE>                      166,681
<INCOME-TAX-EXPENSE>                             7,063
<OTHER-OPERATING-EXPENSES>                     134,949
<TOTAL-OPERATING-EXPENSES>                     142,012
<OPERATING-INCOME-LOSS>                         24,669
<OTHER-INCOME-NET>                                (289)
<INCOME-BEFORE-INTEREST-EXPEN>                  24,380
<TOTAL-INTEREST-EXPENSE>                        12,108
<NET-INCOME>                                    12,272
<PREFERRED-STOCK-DIVIDENDS>                          0
<EARNINGS-AVAILABLE-FOR-COMM>                   12,272
<COMMON-STOCK-DIVIDENDS>                        13,380
<TOTAL-INTEREST-ON-BONDS>                        7,019
<CASH-FLOW-OPERATIONS>                          23,738
<EPS-PRIMARY>                                        0<F1>
<EPS-DILUTED>                                        0<F1>
<FN>
<F1> All common stock owned by parent company; no EPS required.
</FN>
        

</TABLE>
#### NIEHAGE v. AUTO PARTS, INC.

No. 232 PC.

Case below: 41 N.C. App. 538.

Petition by plaintiff for discretionary review under G.S. 7A-31 denied 10 September 1979.
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 1 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 2 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 3 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 4 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 5 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 6 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 7 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 8 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 9 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 10 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 11 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 12 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 13 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 14 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 15 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 16 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 17 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 18 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 19 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 20 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 21 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 22 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 23 of 24
Case 1:07-cv-03580-DLC Document 16 Filed 06/08/2007 Page 24 of 24
[Federal Register Volume 72, Number 189 (Monday, October 1, 2007)]
[Notices]
[Page 55741]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-4830]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF ARCTIC RESEARCH COMMISSION

Arctic Research Commission

[Docket No. USARC 07-081]


Notice of Meeting

September 14, 2007.
    Notice is hereby given that the U.S. Arctic Research Commission 
will hold its 84th meeting in Nome, AK on October 8-9, 2007. the 
Business Session, open to the public, will convene at 9 a.m. Monday, 
October 8, 2007 in Nome, AK. An Executive Session will follow 
adjournment of the Business Session.
    The Agenda items include:
    (1) Call to order and approval of the Agenda.
    (2) Approval of the Minutes of the 83rd Meeting.
    (3) Reports from Congressional Liaisons.
    (4) Agency Reports.
    The focus of the meeting will be reports and updates on programs 
and research projects affecting the Arctic.
    Any person planning to attend this meeting who requires special 
accessibility features and/or auxiliary aids, such as sign language 
interpreters, must inform the Commission in advance of those needs.
    Contact Person for More Information: John Farrell, Executive 
Director, US Arctic Research Commission 703-525-0111 or TDD 703-306-
0090.

John Farrell,
Executive Director.
[FR Doc. 07-4830 Filed 9-28-07; 8:45 am]
BILLING CODE 7555-01-M
UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF NEW YORK

JOHN E. ANDRUS MEMORIAL, INC. (d/b/a ANDRUS 

ON HUDSON),

Plaintiff,

-againstRICHARD F. DAINES, as Commissioner of the New York 

State Department of Health,

Defendant.

x

:

:

:

:

:

:

:

:

:

:

:

:

:

x

2007 Civ. 3432 (CLB)(MDF)

AFFIRMATION OF

SERVICE

STATE OF NEW YORK )

: ss.:

COUNTY OF NEW YORK )

BRIAN T. MCGOVERN, an attorney at law of the State of New York affirms, 

under penalty of perjury, that:

1) I am not a party to this action, am over 18 years of age and reside in Sea 

Cliff, New York.

2) On April 11, 2008, I caused to be served Plaintiff John E. Andrus 

Memorial, Inc.’s Notice of Motion for a Preliminary Injunction, Affidavit of Betsy Biddle in 

Support of Plaintiff’s Motion for a Preliminary Injunction, Memorandum of Law in Support of

Case 7:07-cv-03432-CS-MDF Document 27-2 Filed 04/15/2008 Page 1 of 2
-2-

Plaintiff’s Motion for a Preliminary Injunction, and Proposed Findings of Fact in Support of 

Plaintiff’s Motion for a Preliminary Injunction by sending a true copy thereof via electronic mail 

to John Gasior, attorney for the defendant.

Dated: April 15, 2008

s/Brian T. McGovern

Brian T. McGovern

Case 7:07-cv-03432-CS-MDF Document 27-2 Filed 04/15/2008 Page 2 of 2
#### STATE v. GAGNE

No. 65 PC.

Case below: 22 N.C. App. 615.

.Petition for writ of certiorari to North Carolina Court of Appeals denied 24 September 1974.
#### STATE v. FUTRELL

No. 75 PC.

Case below: 39 N.C. App. 674.

Petition by defendant for discretionary review under G.S. 7A-31 denied 5 June 1979. Motion of Attorney General to dismiss appeal for lack of substantial constitutional question allowed 5 June 1979.
#### LEDWELL v. BERRY

No. 191 P.C.

Case below: 39 N.C. App. 224.

Petition by plaintiffs for discretionary review under G.S. 7A-31 denied 5 February 1979.
!y F{y Y1'Y ': l ELKC;':*'.:: ~:c;,L., 1 *-& !; C'NITEU STATES DIS'I'RICT COIJRT ? i ! ! DOC 2: ;r S(lU'l'1 IERN DISTRICT Ol NEW YORK i _.__._l.r_ _ E, i \\;~gr~;~-{i,i:,-;:): --- 5:3&-cR ..," 7; I. - t 

:,__ .--" .--.- ---. .u.-,rrF---"-' .,'+--., .-. .I <.- ' 

IK RE: 

j MAS-I'EK FlLE 

FOSAhl,AX PRODTJCTS LI;\131LI'l'Y I I I'IG.4TION 

I 1 106-MD- 1789 (Jl'K) 

l'hir. Ur)c./,nrr.n~ Kt~/tr!c.s Tu All Acriotw 

OKI)EK FOR ADMISSION PRO HAC \'1C E 

Considcring thc Ccrtiticate oS Good Sta~ldi~~g and all nthcr documents required by Case 

Managenlent Order No. 3 submitted by counsel. IT IS HFREI31' 0RT)ERE':T) that: 

Applicant's Name: S. Lccnan C';irter 

Firm Name: iVnllcr. Lansden. Dortch & Davis, I .I .P 

Address: 51 1 1 Inion Streil.l. Suite 2700 

is adulirtcd to practice pro hac \.ice as cou~lsel for hlcrck & Co., lnc, in the above captionrd case 

\ in the United States District Court for the Suulhel.n Ilistrict of Ncw Ynrk. 

A 

'" Jlaled: ~a~'.. 7008 

New Yorli. Kt.\v I'rlrh 

. . . . . . .- . LfA, - . 

llnitcd Status Ilist rid Judge 

Case 1:07-cv-03467-JFK Document 32 Filed 05/30/2008 Page 1 of 2
CEItTIFICATE OF GOOD STANDING 

; ss, 

.\.lIUULE DISTRICT OF TENNKSSI'II 

1. KEI'I'H 'I'HIIOClihlOII'I'I~.U. Clerk ui' the L'nilcd Slates Ilistrict C:ourt for the Middle 

1)istr.icl of'l'cnncsscc. 

110 I Il-,KIX3Y C'ER'I I1 Y I hat S. KEENAN CARTER lvas duly ndmittcd li! jlrdct~cc in said 

('our1 on ,lutlc 2Sih, 2004, :ind IS in good standing as a rneu~bcr 01' ~hu b;~r 01-said Courr. 

Case 1:07-cv-03467-JFK Document 32 Filed 05/30/2008 Page 2 of 2
NOTICE TO CLERK OF COURT: Please accept this Initiating Complaint as an initial pleading 

pursuant to CMO __, dated ____________, of Hon. Alvin K. Hellerstein in In Re World Trade 

Center Lower Manhattan Disaster Site Litigation, 21 MC 102 (AKH). 

UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF NEW YORK 

--------------------------------------------------------------X 

 

IN RE WORLD TRADE CENTER LOWER 

MANHATTAN DISASTER SITE LITIGATION 

 

--------------------------------------------------------------X 

21 MC 102 (AKH) 

--------------------------------------------------------------X 

XXXXX, 

 Plaintiff(s), 

 -againstXXXXX, 

 Defendants. 

--------------------------------------------------------------X 

 XX Civ. XXXX (AKH) 

INITIATING COMPLAINT

Pursuant to Case Management Order No. __ (“CMO __”) dated June __, 2007 by Hon. 

Alvin K. Hellerstein, U.S.D.J., in In Re World Trade Center Lower Manhattan Disaster Site 

Litigation, 21 MC 102 (AKH), Plaintiff(s) hereby submit this Initiating Complaint against the 

above named Defendants and state: 

1. Plaintiff ____________ (XXXX) [Å last 4 digits of social security number] 

currently resides at ______________. 

2. Plaintiff(s) have a claim for injury against the Defendants named above that 

would be encompassed within the scope of the In Re World Trade Center Lower Manhattan 

Disaster Site Litigation, 21 MC 102 (AKH). 

3. Plaintiffs will file a fully complete Check-Off Complaint under this docket 

number within 30 days of the filing of this Initiating Complaint. 

Case 1:07-cv-03478-AKH Document 3-4 Filed 06/29/2007 Page 1 of 2
NOTICE TO CLERK OF COURT: Please accept this Initiating Complaint as an initial pleading 

pursuant to CMO __, dated ____________, of Hon. Alvin K. Hellerstein in In Re World Trade 

Center Lower Manhattan Disaster Site Litigation, 21 MC 102 (AKH). 

Dated: _____ __, 200X 

{law firm name} 

Attorney(s) for 

Plaintiff(s)_______________________ 

By: ________ 

 {name} 

{law firm address} 

Telephone: _______________ 

Case 1:07-cv-03478-AKH Document 3-4 Filed 06/29/2007 Page 2 of 2