OJS 44 (Rev. 11/04)

 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 INSTR UC TIO NS ON THE REV ERSE O F TH E FO RM .)

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 COND EMNATION CASES, USE THE LOCATION OF THE

 LAND INVOLVED.

(c) Attorney’s (Firm Na me, A ddress, and Telep hone N umbe r) Attorneys (If Known)

II. BASIS OF JURISDICTION (Place an “X ” in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES(Pla ce an “ X” in O ne B ox fo r Pla intiff

(For Diversity Cases O nly) and O ne Bo x for De fendant) 

 1 U.S. G overnment  3 Federal Question

 

PTF DEF PTF DEF

Pla intiff (U.S. G overnment N ot a Party) Citizen o f This State  1  1 Incorporated or Principal Place  4  4

of Busine ss In This State

 2 U.S. G overnment  4 Diversity Citizen o f Anothe r State  2  2 Incorporated and Principal Place  5  5

Defenda nt (Indicate C itizenship of Pa rties in Item III) of Busine ss In A nother S tate

Citizen or Subje ct o f a  3  3 Foreign Nation  6  6

 Foreign C ountry

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

CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES

110 Insurance PERSONAL INJURY PERSONAL INJURY 610 Agriculture 422 Appeal 28 USC 158 400 S tate Reap portionment

120 M arine 310 A irplane 362 P ersonal Injury - 620 O ther Food & Drug 423 Withdrawal 410 Antitrust

130 Miller Act 315 Airplane Product Med. M alpractice 625 Drug Re lated Se izure 28 USC 157 430 Banks and B anking

140 N egotiable Instrument Liability 365 P ersonal Injury - of Property 21 USC 881 450 Commerce

150 R ecovery of O verpayment 32 0 A ssa ult, Libe l & Prod uct Liability 630 Liquor Laws PROPERTY RIGHTS 460 Deportation

& Enforcement of Judgment Slander 368 Asbestos Personal 640 R.R. & Truck 820 Co pyrights 470 R acketeer Influenced and

151 Medicare Act 330 Federal Employers’ Injury Product 650 Airline Regs. 830 P atent Corrupt O rganizations

152 Recovery of Defaulted Liability Liability 660 Occupational 840 Trad ema rk 48 0 Cons ume r Cred it

Student Loans 340 M arine PERSONAL PROPERTY Safety/H ealth 490 Cable/Sat TV

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

153 R ecovery of O verpayment Liability 371 Truth in Lending LABOR SOCIAL SECURITY 850 Securities/Commodities/

 of Ve teran’s Bene fits 35 0 M oto r Vehic le 380 Other Personal 710 Fair Labor Standards 86 1 H IA (13 95 ff) Exchange

160 Stock holders’ Suits 35 5 M oto r Vehic le Property D amage Act 862 Black Lung (923) 875 C ustomer Challenge

190 Other Contract Prod uct Liability 385 P roperty Damage 720 La bor/M gmt. Relations 863 DIW C/D IWW (405 (g)) 12 USC 3410

195 Co ntract Pro duct Liab ility 360 Other Personal Prod uct Liability 730 La bor/M gmt.Repo rting 864 SSID Title XVI 890 O ther Statutory Actions

196 Franchise Injury & Disclosure Act 865 RS I (405 (g)) 891 Agricultural Ac ts

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

210 Land Condemnation 441 V oting 510 M otions to V acate 790 Other Labor Litigation 87 0 Taxe s (U .S. Pla intiff 893 Environmental M atters

220 Forec losure 442 Employment Sentence 791 Empl. Ret. Inc. or D efenda nt) 894 Energy Allocation Act

230 R ent Lease & Ejectment 443 H ousing/ Habeas Corpus: Security Act 871 IRS—Third Pa rty 895 Freedom of Information

240 Torts to Land Accommod ations 530 General 26 USC 7609 Act

245 Tort P roduc t Liability 444 Welfare 535 De ath Pe nalty 900Appeal of Fee Determination

290 All Othe r Re al Prop erty 445 Amer. w/Disabilities - 540 Mandamus & O ther Under Equal Access

Employme nt 550 Civil Rights to Justice

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

Other State Statutes

440 Othe r Civil Rights

V. ORIGIN

Transferred from

another district

(specify)

Appeal to District

Judge from

Magistrate

Judgment

 (Place an “X ” in One Box Only)

 1 Original

Proceeding

 2 Removed from

State Court

 3 Remanded from

Appellate Court

 4 Reinstated or

Reopened

 5  6 Multidistrict

Litigation

 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:

 CHECK IF THIS IS A CLASS ACTION

UNDER F.R.C.P. 23

DEMAND $ CHECK YES only if demanded in complaint:

JURY DEMAND:  Yes  No

DATE SIGNATURE OF ATTORNEY OF RECORD

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLY ING IFP JUDGE MAG. JUDGE

Case No. 1:11-cv-02613-DME-MEH Document 1-3 filed 10/06/11 USDC Colorado pg 1 of 2
JS 44 Reverse (Rev. 11/04)

INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44

Authority For Civil Cover Sheet

The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading 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. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint

filed. The attorney filing a case should complete the form as follows:

I. (a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only

the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving

both name and title.

(b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time

of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases,

the county of residence of the “defendant” is the location of the tract of land involved.)

(c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting

in this section “(see attachment)”.

 II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires that jurisdictions be shown in pleadings. Place an “X” in one

of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below.

United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here.

United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an “X” in this box.

Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the

Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box

1 or 2 should be marked.

Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the

different parties must be checked. (See Section III below; federal question actions take precedence over diversity cases.)

III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this section

for each principal party.

IV. Nature of Suit. Place an “X” in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is sufficient

to enable the deputy clerk or the statistical clerks in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select

the most definitive.

V. Origin. Place an “X” in one of the seven boxes.

Original Proceedings. (1) Cases which originate in the United States district courts.

Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition

for removal is granted, check this box.

Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date.

Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date.

Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict

litigation transfers.

Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box

is checked, do not check (5) above.

Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judge’s decision.

VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes

unless diversity. Example: U.S. Civil Statute: 47 USC 553

Brief Description: Unauthorized reception of cable service

VII. Requested in Complaint. Class Action. Place an “X” in this box if you are filing a class action under Rule 23, F.R.Cv.P.

Demand. In this space enter the dollar amount (in thousands of dollars) being demanded or indicate other demand such as a preliminary injunction.

Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded.

Date and Attorney Signature. Date and sign the civil cover sheet.

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