CIVIL COVER SHEET

The 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 isrequired 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.)

 (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 CONDEMNATION CASES, USE THE LOCATION OF THE

 LAND INVOLVED.

(c) Attorney’s (Firm Name, Address, and Telephone Number) Attorneys (If Known)

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) 

 PTF DEF PTF DEF

1 U.S. Government 3 Federal Question Citizen of This State 1 1 Incorporated or Principal Place 4 4

Plaintiff (U.S. Government Not a Party) 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 of Business In Another State

in Item III)

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 PERSONAL INJURY PERSONAL INJURY 610 Agriculture 422 Appeal 28 USC 158 400 State Reapportionment

120 Marine 310 Airplane 362 Personal Injury— 620 Other Food & Drug 410 Antitrust

130 Miller Act 315 Airplane Product Med. Malpractice 625 Drug Related Seizure 423 Withdrawal 430 Banks and Banking

140 Negotiable Instrument Liability 365 Personal Injury — of Property 21 USC 881 28 USC 157 450 Commerce/ICC Rates/etc.

150 Recovery of Overpayment 320 Assault, Libel & Product Liability 630 Liquor Laws 460 Deportation

 & Enforcement of Judgment Slander 368 Asbestos Personal 640 R.R. & Truck PROPERTY RIGHTS 470 Racketeer Influenced and

151 Medicare Act 330 Federal Employers’ Injury Product 650 Airline Regs. Corrupt Organizations 820 Copyrights 152 Recovery of Defaulted Liability Liability 660 Occupational 480 Consumer Credit 830 Patent Student Loans (excl. vet.) 340 Marine PERSONAL PROPERTY Safety/Health 490 Cable/Satellite TV 840 Trademark 153 Recovery of Overpayment 345 Marine Product 370 Other Fraud 690 Other 810 Selective Service

 of Veteran’s Benefits Liability 371 Truth in Lending 850 Security/Commodity/Exch.

160 Stockholders’ Suits 350 Motor Vehicle 380 Other Personal LABOR SOCIAL SECURITY 875 Customer Challenge 

190 Other Contract 355 Motor Vehicle Property Damage 12 USC 3410 710 Fair Labor Standards 861 HIA (1395ff) 195 Contract Product Liability Product Liability 385 Property Damage 891 Agricultural Acts Act 862 Black Lung (923)

196 Franchise 360 Other Personal Inj. Product Liability 892 Economic Stabilization Act 720 Labor/Mgmt. Relations 863 DIWC/DIWW (405(g))

893 Environmental Matters

REALPROPERTY CIVIL RIGHTS PRISONER PETITIONS 864 SSID Title XVI 894 Energy Allocation Act 730 Labor/Mgmt.Reporting 865 RSI (405(g)) 895 Freedom of Information Act 210 Land Condemnation 441 Voting 510 Motions to Vacate & Disclosure Act

FEDERAL TAX SUITS 900 Appeal of Fee 220 Foreclosure 442 Employment Sentence 740 Railway Labor Act Determination Under 230 Rent Lease & Ejectment 443 Housing/ Habeas Corpus: 870 Taxes (U.S. Plaintiff Equal Access to Justice 240 Torts to Land Accommodations 530 General 790 Other Labor Litigation or Defendant) 950 Constitutionality of 245 Tort Product Liability 444 Welfare 535 Death Penalty State Statutes 290 All Other Real Property 445 ADA—-Employment 540 Mandamus & Other 791 Empl. Ret. Inc. 871 IRS—Third Party 890 Other Statutory Actions

446 ADA — Other 550 Civil Rights Security Act 26 USC 7609

440 Other Civil Rights 555 Prison Condition

V. ORIGIN (PLACE AN “X” IN ONE BOX ONLY)

Transferred from

another district

(specify)

Appeal to District

Judge from

Magistrate

Judgment 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 (Enter U.S. Civil Statute under which you are filing and write

a brief statement of cause.)

VII. PREVIOUS BANKRUPTCY MATTERS (For nature of

suit 422 and 423, enter the case number and judge for any associated 

bankruptcy matter perviously adjudicated by a judge of this Court. Use a

separate attachment if necessary)

VIII. 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

IX. This case is not a refiling of a previously dismissed action.

is a refiling of case number , previously dismissed by Judge

DATE SIGNATURE OF ATTORNEY OF RECORD

Case: 1:20-cv-02626 Document #: 4 Filed: 04/30/20 Page 1 of 1 PageID #:201