5 7

JS 44 (Rev. 12/07) CIVIL COVER SHEET ATTACHMENT A

The JS 44 civil coversheet and the information contained herein neither replace norsupplement the filing and service of pleadings or other papers asrequired by law, except as provided 

by local rules of court. This form, approved by the Judicial Conference of the United Statesin 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

Natasha Witley Delanore, Kemper & Associates, LLC

(b) County of Residence of First Listed Plaintiff County of Pueblo County of Residence of First Listed Defendant State of Georgia

 (EXCEPT IN U.S. PLAINTIFF CASES) (EXCEPT IN(IUN.SU..PSL. PALINATINIFTFIFCFACSEASSE) S ONLY)

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

 INVOLVED.

(c) Attorney’s (Firm Name, Address, and Telephone Number) AttornAetytosr(nIf Known) eys (If Known)

Lark Fogel, Esq., Of Counsel to Lemberg & Associates, LLC, 1100 

Summer Street, 3rd Floor, Stamford, CT 06905, (203) 653-2250

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)

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

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

of Business In This State

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

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

Citizen or Subject of a 3 3 Foreign Nation 6 6

Foreign Country

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

CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES

110 Insurance

120 Marine

130 Miller Act

140 Negotiable Instrument

150 Recovery of Overpayment

& Enforcement ofJudgment

151 Medicare Act

152 Recovery of Defaulted

Student Loans

(Excl. Veterans)

153 Recovery of Overpayment 

of Veteran’s Benefits

160 Stockholders’ Suits

190 Other Contract

195 Contract Product Liability

196 Franchise

PERSONAL INJURY PERSONAL INJURY

310 Airplane 362 Personal Injury -

315 Airplane Product Med. Malpractice

Liability 365 Personal Injury -

320 Assault, Libel & Product Liability

Slander 368 Asbestos Personal

330 Federal Employers’ Injury Product

Liability Liability

340 Marine PERSONAL PROPERTY

345 Marine Product 370 Other Fraud

Liability 371 Truth in Lending

350 Motor Vehicle 380 Other Personal

355 Motor Vehicle Property Damage

Product Liability 385 Property Damage

360 Other Personal Product Liability

Injury

610 Agriculture

620 Other Food & Drug

625 Drug Related Seizure

of Property 21 USC 881

630 Liquor Laws

640 R.R. & Truck

650 Airline Regs.

660 Occupational

Safety/Health

690 Other

422 Appeal 28 USC 158

423 Withdrawal

28 USC 157

400 State Reapportionment

410 Antitrust

430 Banks and Banking

450 Commerce

460 Deportation

470 Racketeer Influenced and

Corrupt Organizations

480 Consumer Credit

490 Cable/Sat TV

810 Selective Service

850 Securities/Commodities/ 

Exchange

875 Customer Challenge

12 USC 3410

890 Other Statutory Actions

891 Agricultural Acts

892 Economic Stabilization Act

893 Environmental Matters

894 Energy Allocation Act

895 Freedom of Information

Act

900Appeal of Fee Determination

Under Equal Access 

to Justice

950 Constitutionality of

State Statutes

PROPERTY RIGHTS

820 Copyrights

830 Patent

840 Trademark

LABOR SOCIAL SECURITY

710 Fair Labor Standards

Act

720 Labor/Mgmt. Relations

730 Labor/Mgmt.Reporting

& Disclosure Act

740 Railway Labor Act

790 Other Labor Litigation

791 Empl. Ret. Inc.

Security Act

861 HIA (1395ff)

862 Black Lung (923)

863 DIWC/DIWW (405(g))

864 SSID Title XVI

865 RSI (405(g))

REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS FEDERAL TAX SUITS

210 Land Condemnation

220 Foreclosure

230 Rent Lease & Ejectment

240 Torts to Land

245 Tort Product Liability

290 All Other Real Property

441 Voting

442 Employment

443 Housing/ 

Accommodations

444 Welfare

445 Amer. w/Disabilities -

Employment

446 Amer. w/Disabilities -

Other

440 Other Civil Rights

510 Motions to Vacate

Sentence

Habeas Corpus:

530 General

535 Death Penalty

540 Mandamus & Other

550 Civil Rights

555 Prison Condition

870 Taxes (U.S. Plaintiff

or Defendant)

871 IRS—Third Party

26 USC 7609

IMMIGRATION

462 Naturalization Application

463 Habeas Corpus -

Alien Detainee

465 Other Immigration

Actions

V. ORIGIN

1 Original

Proceeding

(Place an “X” in One Box Only)

2 Removed from

State Court

3 Remanded from

Appellate Court

4 Reinstated or

Reopened

Transferred from 

another district 

(specify)

6 Multidistrict

Litigation

Appeal to District 

Judge from 

Magistrate 

Judgment

VI. CAUSE OF ACTION

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

15 USC 1692

Brief description of cause:

Violations of the Fair Debt Collection Practices Act

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

COMPLAINT: UNDERF.R.C.P.23 25,000.00

VIII. RELATED CASE(S)

JURY DEMAND: Yes No 

IF ANY (See instructions):

JUDGE DOCKET NUMBER

DATE SIGNATURE OF ATTORNEY OF RECORD

July 5, 2011 /s/ Lark Fogel

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE

Case 1:11-cv-01750-PAB -MJW Document 1-1 Filed 07/05/11 USDC Colorado Page 1 of 1