2
JS 44C/SDNY REV. 10/01/2020 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 use of the Clerk of Court for the purpose of initiating the civil docket sheet. PLAINTIFFS DEFENDANTS ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE NUMBER ATTORNEYS (IF KNOWN) CAUSE OF ACTION (CITE THE U.S. CIVIL STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE ) (DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY) Has this action, case, or proceeding, or one essentially the same been previously filed in SDNY at any time? No Yes Judge Previously Assigned If yes, was this case Vol. Invol. Dismissed. No Yes If yes, give date _______________________ & Case No. ______________________ IS THIS AN INTERNATIONAL ARBITRATION CASE? No Yes (PLACE AN [x] IN ONE BOX ONLY) NATURE OF SUIT CONTRACT [ ] 110 INSURANCE [ ] 120 MARINE [ ] 130 MILLER ACT [ ] 140 NEGOTIABLE INSTRUMENT [ ] 150 RECOVERY OF OVERPAYMENT & ENFORCEMENT OF JUDGMENT [ ] 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 REAL PROPERTY [ ] 210 LAND CONDEMNATION [ ] 220 FORECLOSURE [ ] 230 RENT LEASE & EJECTMENT [ ] 240 TORTS TO LAND [ ] 245 TORT PRODUCT LIABILITY [ ] 290 ALL OTHER REAL PROPERTY TORTS PERSONAL INJURY [ ] 310 AIRPLANE [ ] 315 AIRPLANE PRODUCT LIABILITY [ ] 320 ASSAULT, LIBEL & SLANDER [ ] 330 FEDERAL EMPLOYERS' LIABILITY [ ] 340 MARINE [ ] 345 MARINE PRODUCT LIABILITY [ ] 350 MOTOR VEHICLE [ ] 355 MOTOR VEHICLE PRODUCT LIABILITY [ ] 360 OTHER PERSONAL INJURY ACTIONS UNDER STATUTES CIVIL RIGHTS PERSONAL INJURY [ ] 365 PERSONAL INJURY PRODUCT LIABILITY [ ] 368 ASBESTOS PERSONAL INJURY PRODUCT LIABILITY PERSONAL PROPERTY [ ] 370 OTHER FRAUD [ ] 371 TRUTH IN LENDING [ ] 380 OTHER PERSONAL PROPERTY DAMAGE [ ] 385 PROPERTY DAMAGE PRODUCT LIABILITY PRISONER PETITIONS [ ] 510 MOTIONS TO VACATE SENTENCE 28 USC 2255 [ ] 530 HABEAS CORPUS [ ] 535 DEATH PENALTY [ ] 540 MANDAMUS & OTHER PRISONER CIVIL RIGHTS [ ] 550 CIVIL RIGHTS [ ] 555 PRISON CONDITION FORFEITURE/PENALTY 21 USC 881 LABOR [ ] 710 FAIR LABOR STANDARDS ACT [ ] 720 LABOR/MGMT RELATIONS [ ] 740 RAILWAY LABOR ACT [ ] 751 FAMILY MEDICAL LEAVE ACT (FMLA) [ ] 790 OTHER LABOR LITIGATION [ ] 791 EMPL RET INC SECURITY ACT (ERISA) IMMIGRATION [ ] 462 NATURALIZATION APPLICATION [ ] 465 OTHER IMMIGRATION ACTIONS CONDITIONS OF CONFINEMENT ACTIONS UNDER STATUTES BANKRUPTCY [ ] 422 APPEAL 28 USC 158 [ ] 423 WITHDRAWAL 28 USC 157 PROPERTY RIGHTS [ ] 820 COPYRIGHTS [ ] 830 PATENT [ ] 840 TRADEMARK SOCIAL SECURITY [ ] 861 HIA (1395ff) [ ] 862 BLACK LUNG (923) [ ] 863 DIWC/DIWW (405(g)) [ ] 864 SSID TITLE XVI [ ] 865 RSI (405(g)) FEDERAL TAX SUITS [ ] 870 TAXES (U.S. Plaintiff or Defendant) [ ] 871 IRS-THIRD PARTY 26 USC 7609 OTHER STATUTES [ ] 400 STATE REAPPORTIONMENT [ ] 410 ANTITRUST [ ] 430 BANKS & BANKING [ ] 450 COMMERCE [ ] 460 DEPORTATION [ ] 470 RACKETEER INFLU- ENCED & CORRUPT ORGANIZATION ACT (RICO) [ ] 480 CONSUMER CREDIT [ ] 490 CABLE/SATELLITE TV [ ] 850 SECURITIES/ COMMODITIES/ EXCHANGE [ ] 890 OTHER STATUTORY ACTIONS [ ] 891 AGRICULTURAL ACTS [ ] 893 ENVIRONMENTAL MATTERS [ ] 895 FREEDOM OF INFORMATION ACT [ ] 896 ARBITRATION [ ] 899 ADMINISTRATIVE PROCEDURE ACT/REVIEW OR APPEAL OF AGENCY DECISION Check if demanded in complaint: CHECK IF THIS IS A CLASS ACTION DO YOU CLAIM THIS CASE IS RELATED TO A CIVIL CASE NOW PENDING IN S.D.N.Y. AS DEFINED BY LOCAL RULE FOR DIVISION OF BUSINESS 13? UNDER F.R.C.P. 23 IF SO, STATE: DEMAND $______________ OTHER ______________ JUDGE _________________________________ DOCKET NUMBER_________________ Check YES only if demanded in complaint JURY DEMAND: YES NO NOTE: You must also submit at the time of filing the Statement of Relatedness form (Form IH-32). [ ] 690 OTHER [ ] 625 DRUG RELATED SEIZURE OF PROPERTY [ ] 560 CIVIL DETAINEE DISABILITIES -OTHER [ ] 446 AMERICANS WITH EMPLOYMENT DISABILITIES - [ ] 445 AMERICANS WITH ACCOMMODATIONS [ ] 443 HOUSING/ [ ] 442 EMPLOYMENT [ ] 441 VOTING [ ] 440 OTHER CIVIL RIGHTS (Non-Prisoner) [ ] 375 FALSE CLAIMS [ ] 448 EDUCATION [ ] 463 ALIEN DETAINEE [ ] 362 PERSONAL INJURY - MED MALPRACTICE [ ] 367 HEALTHCARE/ PHARMACEUTICAL PERSONAL INJURY/PRODUCT LIABILITY [ ] 950 CONSTITUTIONALITY OF STATE STATUTES [ ] 376 QUI TAM [ ] 835 PATENT-ABBREVIATED NEW DRUG APPLICATION [ ] 485 TELEPHONE CONSUMER PROTECTION ACT [ ] 880 DEFEND TRADE SECRETS ACT

NATURE OF SUIT - Homepage | U.S District Court...10/01/2020. CIVIL COVER SHEET. The JS-44 civil cover sheet and the information contained herein neither replace nor supplement the

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  • JS 44C/SDNY REV. 10/01/2020

    CIVIL COVER SHEETThe 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 use of the Clerk of Court for the purpose of initiating the civil docket sheet.

    PLAINTIFFS DEFENDANTS

    ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE NUMBER ATTORNEYS (IF KNOWN)

    CAUSE OF ACTION (CITE THE U.S. CIVIL STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE)(DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY)

    Has this action, case, or proceeding, or one essentially the same been previously filed in SDNY at any time? No YesJudge Previously Assigned

    If yes, was this case Vol. Invol. Dismissed. No Yes If yes, give date _______________________ & Case No. ______________________

    IS THIS AN INTERNATIONAL ARBITRATION CASE? No Yes

    (PLACE AN [x] IN ONE BOX ONLY) NATURE OF SUIT

    CONTRACT

    [ ] 110 INSURANCE[ ] 120 MARINE[ ] 130 MILLER ACT[ ] 140 NEGOTIABLE

    INSTRUMENT[ ] 150 RECOVERY OF

    OVERPAYMENT &ENFORCEMENTOF JUDGMENT

    [ ] 151 MEDICARE ACT[ ] 152 RECOVERY OF

    DEFAULTEDSTUDENT LOANS(EXCL VETERANS)

    [ ] 153 RECOVERY OFOVERPAYMENTOF VETERAN'SBENEFITS

    [ ] 160 STOCKHOLDERSSUITS

    [ ] 190 OTHERCONTRACT

    [ ] 195 CONTRACTPRODUCTLIABILITY

    [ ] 196 FRANCHISE

    REAL PROPERTY

    [ ] 210 LANDCONDEMNATION

    [ ] 220 FORECLOSURE[ ] 230 RENT LEASE &

    EJECTMENT[ ] 240 TORTS TO LAND[ ] 245 TORT PRODUCT

    LIABILITY[ ] 290 ALL OTHER

    REAL PROPERTY

    TORTS

    PERSONAL INJURY

    [ ] 310 AIRPLANE[ ] 315 AIRPLANE PRODUCT

    LIABILITY[ ] 320 ASSAULT, LIBEL &

    SLANDER[ ] 330 FEDERAL

    EMPLOYERS'LIABILITY

    [ ] 340 MARINE[ ] 345 MARINE PRODUCT

    LIABILITY[ ] 350 MOTOR VEHICLE[ ] 355 MOTOR VEHICLE

    PRODUCT LIABILITY[ ] 360 OTHER PERSONAL

    INJURY

    ACTIONS UNDER STATUTES

    CIVIL RIGHTS

    PERSONAL INJURY

    [ ] 365 PERSONAL INJURYPRODUCT LIABILITY

    [ ] 368 ASBESTOS PERSONALINJURY PRODUCTLIABILITY

    PERSONAL PROPERTY

    [ ] 370 OTHER FRAUD[ ] 371 TRUTH IN LENDING

    [ ] 380 OTHER PERSONALPROPERTY DAMAGE

    [ ] 385 PROPERTY DAMAGEPRODUCT LIABILITY

    PRISONER PETITIONS

    [ ] 510 MOTIONS TOVACATE SENTENCE28 USC 2255

    [ ] 530 HABEAS CORPUS[ ] 535 DEATH PENALTY[ ] 540 MANDAMUS & OTHER

    PRISONER CIVIL RIGHTS

    [ ] 550 CIVIL RIGHTS[ ] 555 PRISON CONDITION

    FORFEITURE/PENALTY

    21 USC 881

    LABOR

    [ ] 710 FAIR LABORSTANDARDS ACT

    [ ] 720 LABOR/MGMTRELATIONS

    [ ] 740 RAILWAY LABOR ACT[ ] 751 FAMILY MEDICAL LEAVE ACT (FMLA)

    [ ] 790 OTHER LABORLITIGATION

    [ ] 791 EMPL RET INCSECURITY ACT (ERISA)

    IMMIGRATION

    [ ] 462 NATURALIZATIONAPPLICATION

    [ ] 465 OTHER IMMIGRATIONACTIONS

    CONDITIONS OF CONFINEMENT

    ACTIONS UNDER STATUTES

    BANKRUPTCY

    [ ] 422 APPEAL28 USC 158

    [ ] 423 WITHDRAWAL28 USC 157

    PROPERTY RIGHTS

    [ ] 820 COPYRIGHTS[ ] 830 PATENT

    [ ] 840 TRADEMARKSOCIAL SECURITY

    [ ] 861 HIA (1395ff)[ ] 862 BLACK LUNG (923)[ ] 863 DIWC/DIWW (405(g))[ ] 864 SSID TITLE XVI[ ] 865 RSI (405(g))

    FEDERAL TAX SUITS

    [ ] 870 TAXES (U.S. Plaintiff orDefendant)

    [ ] 871 IRS-THIRD PARTY26 USC 7609

    OTHER STATUTES

    [ ] 400 STATEREAPPORTIONMENT

    [ ] 410 ANTITRUST[ ] 430 BANKS & BANKING[ ] 450 COMMERCE[ ] 460 DEPORTATION[ ] 470 RACKETEER INFLU-

    ENCED & CORRUPTORGANIZATION ACT(RICO)

    [ ] 480 CONSUMER CREDIT

    [ ] 490 CABLE/SATELLITE TV[ ] 850 SECURITIES/

    COMMODITIES/EXCHANGE

    [ ] 890 OTHER STATUTORYACTIONS

    [ ] 891 AGRICULTURAL ACTS[ ] 893 ENVIRONMENTAL

    MATTERS[ ] 895 FREEDOM OF

    INFORMATION ACT[ ] 896 ARBITRATION[ ] 899 ADMINISTRATIVE

    PROCEDURE ACT/REVIEW OR APPEAL OF AGENCY DECISION

    Check if demanded in complaint:

    CHECK IF THIS IS A CLASS ACTIONDO YOU CLAIM THIS CASE IS RELATED TO A CIVIL CASE NOW PENDING IN S.D.N.Y. AS DEFINED BY LOCAL RULE FOR DIVISION OF BUSINESS 13?

    UNDER F.R.C.P. 23 IF SO, STATE:

    DEMAND $______________ OTHER ______________ JUDGE _________________________________ DOCKET NUMBER_________________

    Check YES only if demanded in complaintJURY DEMAND: YES NO NOTE: You must also submit at the time of filing the Statement of Relatedness form (Form IH-32).

    [ ] 690 OTHER

    [ ] 625 DRUG RELATEDSEIZURE OF PROPERTY

    [ ] 560 CIVIL DETAINEE

    DISABILITIES -OTHER[ ] 446 AMERICANS WITH

    EMPLOYMENTDISABILITIES -

    [ ] 445 AMERICANS WITHACCOMMODATIONS

    [ ] 443 HOUSING/[ ] 442 EMPLOYMENT[ ] 441 VOTING

    [ ] 440 OTHER CIVIL RIGHTS (Non-Prisoner)

    [ ] 375 FALSE CLAIMS

    [ ] 448 EDUCATION

    [ ] 463 ALIEN DETAINEE

    [ ] 362 PERSONAL INJURY -MED MALPRACTICE

    [ ] 367 HEALTHCARE/PHARMACEUTICAL PERSONAL INJURY/PRODUCT LIABILITY

    [ ] 950 CONSTITUTIONALITY OF STATE STATUTES

    [ ] 376 QUI TAM

    [ ] 835 PATENT-ABBREVIATED NEW DRUG APPLICATION

    [ ] 485 TELEPHONE CONSUMER PROTECTION ACT

    [ ] 880 DEFEND TRADE SECRETS ACT

  • (PLACE AN x IN ONE BOX ONLY) ORIGIN1 Original

    Proceeding2 Removed from

    State Court

    a. all parties represented

    b. At least one party is pro se.

    3 Remanded from Appellate Court

    4 Reinstated or Reopened

    5 Transferred from (Specify District)

    6 Appeal to District Judge from Magistrate Judge

    (PLACE AN x IN ONE BOX ONLY) BASIS OF JURISDICTION IF DIVERSITY, INDICATE1 U.S. PLAINTIFF 2 U.S. DEFENDANT 3 FEDERAL QUESTION 4 DIVERSITY

    (U.S. NOT A PARTY)CITIZENSHIP BELOW.

    CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY)

    (Place an [X] in one box for Plaintiff and one box for Defendant)

    PTF DEF PTF DEF PTF DEFCITIZEN OF THIS STATE [ ] 1 [ ] 1 CITIZEN OR SUBJECT OF A [ ] 3 [ ] 3 INCORPORATED and PRINCIPAL PLACE [ ] 5 [ ] 5

    FOREIGN COUNTRY OF BUSINESS IN ANOTHER STATE

    CITIZEN OF ANOTHER STATE [ ] 2 [ ] 2 INCORPORATED or PRINCIPAL PLACE [ ] 4 [ ] 4 FOREIGN NATION [ ] 6 [ ] 6 OF BUSINESS IN THIS STATE

    PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES)

    DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES)

    DEFENDANT(S) ADDRESS UNKNOWNREPRESENTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DILIGENCE, TO ASCERTAIN THE RESIDENCE ADDRESSES OF THE FOLLOWING DEFENDANTS:

    Check one: THIS ACTION SHOULD BE ASSIGNED TO: WHITE PLAINS MANHATTAN

    DATE

    RECEIPT #

    SIGNATURE OF ATTORNEY OF RECORDADMITTED TO PRACTICE IN THIS DISTRICT[ ] NO[ ] YES (DATE ADMITTED Mo. _______ Yr. _______)Attorney Bar Code #

    Magistrate Judge is to be designated by the Clerk of the Court.

    Magistrate Judge _________________________________________________________ is so Designated.

    Ruby J. Krajick, Clerk of Court by _____________ Deputy Clerk, DATED _____________________.

    UNITED STATES DISTRICT COURT (NEW YORK SOUTHERN)

    COURTHOUSE ASSIGNMENTI hereby certify that this case should be assigned to the courthouse indicated below pursuant to Local Rule for Division of Business 18, 20 or 21.

    8

    7Multidistrict Litigation (Transferred)

    Multidistrict Litigation (Direct File)

    9.0.0.2.20120627.2.874785

    NYSD Webmaster

    Civil Cover Sheet

    JS 44C/SDNY REV. 10/01/2020

    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 use of the Clerk of Court for the purpose of initiating the civil docket sheet.

    PLAINTIFFS

    DEFENDANTS

    ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE NUMBER

    ATTORNEYS (IF KNOWN)

    CAUSE OF ACTION

    (CITE THE U.S. CIVIL STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE

    )

    (DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY)

    Has this  action, case, or proceeding, or one essentially the same been previously filed in SDNY at any time?

     No     Yes

    Judge Previously Assigned

    If yes, was this case Vol.

    Invol.

    Dismissed. No

    Yes

    If yes, give date _______________________ & Case No. ______________________

    I

    S THIS AN INTERNATIONAL ARBITRATION CASE? 

    No

    Yes

    (PLACE AN [x] IN ONE BOX ONLY)

    NATURE OF SUIT

    CONTRACT

    [ ] 110

    INSURANCE

    [ ] 120

    MARINE

    [ ] 130

    MILLER ACT

    [ ] 140

    NEGOTIABLE

    INSTRUMENT

    [ ] 150

    RECOVERY OF

    OVERPAYMENT &

    ENFORCEMENT

    OF JUDGMENT

    [ ] 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

    REAL PROPERTY

    [ ] 210

    LAND

    CONDEMNATION

    [ ] 220

    FORECLOSURE

    [ ] 230

    RENT LEASE &

    EJECTMENT

    [ ] 240

    TORTS TO LAND

    [ ] 245

    TORT PRODUCT

    LIABILITY

    [ ] 290

    ALL OTHER

    REAL PROPERTY

    TORTS

    PERSONAL INJURY

    [ ] 310 AIRPLANE

    [ ] 315 AIRPLANE PRODUCT

    LIABILITY

    [ ] 320 ASSAULT, LIBEL &

    SLANDER

    [ ] 330 FEDERAL

    EMPLOYERS'

    LIABILITY

    [ ] 340 MARINE

    [ ] 345 MARINE PRODUCT

    LIABILITY

    [ ] 350 MOTOR VEHICLE

    [ ] 355 MOTOR VEHICLE

    PRODUCT LIABILITY

    [ ] 360 OTHER PERSONAL

    INJURY

    ACTIONS UNDER STATUTES

    CIVIL RIGHTS

    PERSONAL INJURY

    [ ] 365 PERSONAL INJURY

    PRODUCT LIABILITY

    [ ] 368 ASBESTOS PERSONAL

    INJURY PRODUCT

    LIABILITY

    PERSONAL PROPERTY

    [ ] 370 OTHER FRAUD

    [ ] 371 TRUTH IN LENDING

    [ ] 380 OTHER PERSONAL

    PROPERTY DAMAGE

    [ ] 385 PROPERTY DAMAGE

    PRODUCT LIABILITY

    PRISONER PETITIONS

    [ ] 510 MOTIONS TO

    VACATE SENTENCE

    2

    8

    USC 2255

    [ ] 530 HABEAS CORPUS

    [ ] 535 DEATH PENALTY

    [ ] 540 MANDAMUS & OTHER

    PRISONER CIVIL RIGHTS

    [ ] 550 CIVIL RIGHTS

    [ ] 555 PRISON CONDITION

    FORFEITURE/PENALTY

    21 USC 881

    LABOR

    [ ] 710 FAIR LABOR

    STANDARDS ACT

    [ ] 720 LABOR/MGMT

    RELATIONS

    [  ] 740 RAILWAY LABOR ACT

    [  ]   751 FAMILY MEDICAL             LEAVE ACT (FMLA)

    [ ] 790 OTHER LABOR

    LITIGATION

    [ ] 791 EMPL RET INC

    SECURITY ACT (ERISA)

    IMMIGRATION

    [ ] 462 NATURALIZATION

    APPLICATION

    [  ] 465 OTHER IMMIGRATION

    ACTIONS

    CONDITIONS OF CONFINEMENT

    ACTIONS UNDER STATUTES

    BANKRUPTCY

    [ ] 422 APPEAL

    28 USC 158

    [ ] 423 WITHDRAWAL

    28 USC 157

    PROPERTY RIGHTS

    [ ] 820 COPYRIGHTS

    [  ] 830 PATENT

    [ ] 840 TRADEMARK

    SOCIAL SECURITY

    [ ] 861 HIA (1395ff)

    [ ] 862 BLACK LUNG (923)

    [ ] 863 DIWC/DIWW (405(g))

    [ ] 864 SSID TITLE XVI

    [ ] 865 RSI (405(g))

    FEDERAL TAX SUITS

    [ ] 870 TAXES (U.S. Plaintiff or

    Defendant)

    [ ] 871 IRS-THIRD PARTY

    26 USC 7609

    OTHER STATUTES

    [ ] 400 STATE

    REAPPORTIONMENT

    [ ] 410 ANTITRUST

    [ ] 430 BANKS & BANKING

    [ ] 450 COMMERCE

    [ ] 460 DEPORTATION

    [ ] 470 RACKETEER INFLU-

    ENCED & CORRUPT

    ORGANIZATION ACT

    (RICO)

    [ ] 480 CONSUMER CREDIT

    [ ] 490 CABLE/SATELLITE TV

    [ ] 850 SECURITIES/

    COMMODITIES/

    EXCHANGE

    [ ] 890 OTHER STATUTORY

    ACTIONS

    [ ] 891 AGRICULTURAL ACTS

    [ ] 893 ENVIRONMENTAL

    MATTERS

    [  ] 895 FREEDOM OF

    INFORMATION ACT

    [  ]  896 ARBITRATION

    [  ]  899 ADMINISTRATIVE         

    PROCEDURE ACT/REVIEW OR APPEAL OF AGENCY DECISION

    Check if demanded in complaint:

    CHECK IF THIS IS A

    CLASS ACTION

    DO YOU CLAIM THIS CASE IS RELATED TO A CIVIL CASE NOW PENDING IN S.D.N.Y.AS DEFINED BY LOCAL RULE FOR DIVISION OF BUSINESS 13?

    UNDER F.R.C.P. 23

    IF SO, STATE:

    DEMAND

    $______________

    OTHER

    ______________

    JUDGE

    _________________________________

    DOCKET NUMBER

    _________________

    Check YES only if demanded in complaint

    JURY DEMAND: YES NO

    NOTE:

    You must also submit at the time of filing the Statement of Relatedness form (Form IH-32).

    [  ] 690 OTHER

    [ ] 625 DRUG RELATED

    SEIZURE OF PROPERTY

    [  ] 560 CIVIL DETAINEE 

    DISABILITIES -OTHER

    [ ] 446 AMERICANS WITH

    EMPLOYMENT

    DISABILITIES -

    [ ] 445 AMERICANS WITH

    ACCOMMODATIONS

    [ ] 443 HOUSING/

    [ ] 442 EMPLOYMENT

    [ ] 441 VOTING

    [ ] 440 OTHER CIVIL RIGHTS

    (Non-Prisoner)

    [ ] 375 FALSE CLAIMS

    [ ] 448 EDUCATION

    [ ] 463 ALIEN DETAINEE

    [ ] 362 PERSONAL INJURY -

    MED MALPRACTICE

    [  ] 367 HEALTHCARE/PHARMACEUTICAL PERSONAL INJURY/PRODUCT LIABILITY

    [  ] 950 CONSTITUTIONALITY OF STATE STATUTES

    [ ] 376 QUI TAM

    [  ] 835 PATENT-ABBREVIATED NEW DRUG APPLICATION

    [  ] 485 TELEPHONE CONSUMER

                 PROTECTION ACT

    [ ] 880 DEFEND TRADE SECRETS ACT

    (PLACE AN x IN ONE BOX ONLY)

    ORIGIN

    1

    Original Proceeding

    2

    Removed from State Court

    a. 

    all parties represented

    b.

    At least one party is pro se.          

    3

    Remanded from Appellate Court

    4

    Reinstated or Reopened

    5

    Transferred from (Specify District)

    6

    Appeal to District Judge from Magistrate Judge

    (PLACE AN x IN ONE BOX ONLY)

    BASIS OF JURISDICTION

    IF DIVERSITY, INDICATE

    1

    U.S. PLAINTIFF

    2

    U.S. DEFENDANT

    3

    FEDERAL QUESTION

    4

    DIVERSITY

    (U.S. NOT A PARTY)

    CITIZENSHIP BELOW.

    CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY)

    (Place an [X] in one box for Plaintiff and one box for Defendant)

    PTF

    DEF

    PTF DEF

    PTF

    DEF

    CITIZEN OF THIS STATE

    [ ] 1

    [ ] 1

    CITIZEN OR SUBJECT OF A

    [ ] 3 [ ] 3

    INCORPORATED and PRINCIPAL PLACE

    [ ] 5

    [ ] 5

    FOREIGN COUNTRY

    OF BUSINESS IN ANOTHER STATE

    CITIZEN OF ANOTHER STATE

    [ ] 2

    [ ] 2

    INCORPORATED or PRINCIPAL PLACE

    [ ] 4 [ ] 4

    FOREIGN NATION

    [ ] 6

    [ ] 6

    OF BUSINESS IN THIS STATE

    PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES)

    DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES)

    DEFENDANT(S) ADDRESS UNKNOWN

    REPRESENTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DILIGENCE, TO ASCERTAIN THE RESIDENCE ADDRESSES OF THE FOLLOWING DEFENDANTS:

    Check one:

    THIS ACTION SHOULD BE ASSIGNED TO:

    WHITE PLAINS

    MANHATTAN

    DATE

    RECEIPT #

    SIGNATURE OF ATTORNEY OF RECORD

    ADMITTED TO PRACTICE IN THIS DISTRICT

    [ ] NO

    [ ] YES (DATE ADMITTED Mo. _______ Yr. _______)

    Attorney Bar Code #

    Magistrate Judge is to be designated by the Clerk of the Court.

    Magistrate Judge _________________________________________________________ is so Designated.

    Ruby J. Krajick, Clerk of Court by _____________ Deputy Clerk, DATED _____________________.

    UNITED STATES DISTRICT COURT (NEW YORK SOUTHERN)

    COURTHOUSE ASSIGNMENT

    I hereby certify that this case should be assigned to the courthouse indicated below pursuant to Local Rule for Division of Business 18, 20 or 21.

    8

    7

    MultidistrictLitigation(Transferred)

    Multidistrict Litigation (Direct File)

    PLAINTIFFS: DEFENDANTS: ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE NUMBER: ATTORNEYS (IF KNOWN): CAUSE OF ACTION (CITE THE U.S. CIVIL STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE: Check_Box61: OffCheck_Box114: OffText1: If yes, was this case Vol: OffInvol: OffDismissed. No: OffYes: OffIf yes, give date: Case No: NATURE OF SUIT: Check_Box1: OffCheck_Box20: OffCheck_Box41: OffCheck_Box66: OffCheck_Box78: OffCheck_Box3: OffCheck_Box2: OffCheck_Box67: OffCheck_Box4: OffCheck_Box79: OffCheck_Box42: OffCheck_Box21: OffCheck_Box26: OffCheck_Box80: OffCheck_Box43: OffCheck_Box81: OffCheck_Box5: OffCheck_Box82: OffCheck_Box50: OffCheck_Box27: OffCheck_Box83: OffCheck_Box34: OffCheck_Box68: OffCheck_Box6: OffCheck_Box31: OffCheck_Box69: OffCheck_Box7: OffCheck_Box44: OffCheck_Box54: OffCheck_Box70: OffCheck_Box84: OffCheck_Box32: OffCheck_Box45: OffCheck_Box85: OffCheck_Box30: OffCheck_Box46: OffCheck_Box8: OffCheck_Box29: OffCheck_Box47: OffCheck_Box71: OffCheck_Box72: OffCheck_Box73: OffCheck_Box9: OffCheck_Box10: OffCheck_Box11: OffCheck_Box37: OffCheck_Box74: OffCheck_Box75: OffCheck_Box12: OffCheck_Box89: OffCheck_Box90: OffCheck_Box40: OffCheck_Box39: OffCheck_Box92: OffCheck_Box56: OffCheck_Box57: OffCheck_Box58: OffCheck_Box59: OffCheck_Box76: OffCheck_Box60: OffCheck_Box19: OffCheck_Box87: OffCheck_Box38: OffCheck_Box62: OffCheck_Box77: OffCheck_Box95: OffCheck_Box13: OffCheck_Box14: OffCheck_Box25: OffCheck_Box15: OffOTHER: DEMAND: JUDGE: DOCKET NUMBER: JURY DEMAND: OffYES: OffCheck_Box93: OffCheck_Box23: OffCheck_Box36: OffCheck_Box24: OffCheck_Box64: OffCheck_Box96: OffCheck_Box63: OffCheck_Box65: OffCheck_Box28: OffCheck_Box16: OffCheck_Box17: OffCheck_Box35: OffCheck_Box22: OffClass_Action: Off1 Original: Off4 Reinstated or: Off5 Transferred from: Off6 Multidistrict: Off7 Appeal to District: Offa. all parties represented: Offb. At least one: Off1 U.S. PLAINTIFF: Off2 U.S. DEFENDANT: Off3 FEDERAL QUESTION: Off4 DIVERSITY: OffCheck_Box99: OffCheck_Box100: OffCheck_Box103: OffCheck_Box104: OffCheck_Box107: OffCheck_Box108: OffCheck_Box101: OffCheck_Box102: OffCheck_Box105: OffCheck_Box106: OffCheck_Box109: OffCheck_Box110: OffDEFENDANT(S) ADDRESS(ES) AND COUNTY(IES: DEFENDANT(S) ADDRESS UNKNOWN: Text113: WHITE PLAINS: OffMANHATTAN: OffText115: Check_Box111: OffCheck_Box112: OffText114: YES (DATE ADMITTED Mo: undefined: Text116: Magistrate Judge: Ruby J. Krajick, Clerk of Court by: Clear_Form: Save: Print: undefined: 7 Appeal to District: Off4 Reinstated or: Off4 Reinstated or: Off