JS 44 (Rev. 06/17) FLSD Revised 06/01/2017
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 Confer
ence 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 INSTRUCTIONS ON NEXT PAGE OF THIS FORM.) NOTICE: Attorneys MUST Indicate All Re-filed Cases Below.
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 CONDEMNATION CASES, USE THE LOCATION OF
THE TRACT OF LAND INVOLVED.
(c) Attorneys (Firm Name, Address, and Telephone Number)
Attorneys (If Known)
(d)
Check County Where Action Arose: MIAMI- DADE MONROE BROWARD PALM BEACH MARTIN ST. LUCIE INDIAN RIVER OKEECHOBEE HIGHLANDS
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) Click here for: Nature of Suit Code Descriptions
CONTRACT
TORTS
FORFEITURE/PENALTY
BANKRUPTCY
OTHER STATUTES
110 Insurance
PERSONAL INJURY
PERSONAL INJURY
625 Drug Related Seizure
422 Appeal 28 USC 158
375 False Claims Act
120 Marine
310 Airplane
365 Personal Injury -
of Property 21 USC 881
423 Withdrawal
376 Qui Tam (31 USC
130 Miller Act
315 Airplane Product
Product Liability
690 Other
28 USC 157
3729 (a))
140 Negotiable Instrument
Liability
367 Health Care/
400 State Reapportionment
150 Recovery of Overpayment
320 Assault, Libel &
Pharmaceutical
PROPERTY RIGHTS
410 Antitrust
& Enforcement of Judgment
Slander
Personal Injury
820 Copyrights
430 Banks and Banking
151 Medicare Act
330 Federal Employers’
Product Liability
830 Patent
450 Commerce
152 Recovery of Defaulted Liability
368 Asbestos Personal
835 Patent – Abbreviated
New Drug Application
460 Deportation
Student Loans
340 Marine
Injury Product
840 Trademark
470 Racketeer Influenced and
(Excl. Veterans)
345 Marine Product
Liability
LABOR
SOCIAL SECURITY
Corrupt Organizations
153 Recovery of Overpayment
Liability
PERSONAL PROPERTY
710 Fair Labor Standards
861 HIA (1395ff)
480 Consumer Credit
of Veteran’s Benefits
350 Motor Vehicle
370 Other Fraud
Act
862 Black Lung (923)
490 Cable/Sat TV
160 Stockholders’ Suits
355 Motor Vehicle
371 Truth in Lending
720 Labor/Mgmt. Relations
863 DIWC/DIWW (405(g))
850 Securities/Commodities/
190 Other Contract
Product Liability
380 Other Personal
740 Railway Labor Act
864 SSID Title XVI
Exchange
195 Contract Product Liability
360 Other Personal
Property Damage
751 Family and Medical
865 RSI (405(g))
890 Other Statutory Actions
196 Franchise
Injury
385 Property Damage
Leave Act
891 Agricultural Acts
362 Personal Injury -
Product Liability
790 Other Labor Litigation
893 Environmental Matters
Med. Malpractice
791 Empl. Ret. Inc.
895 Freedom of Information
REAL PROPERTY
CIVIL RIGHTS
PRISONER PETITIONS
Security Act
FEDERAL TAX SUITS
Act
210 Land Condemnation
440 Other Civil Rights
Habeas Corpus:
870 Taxes (U.S. Plaintiff
896 Arbitration
220 Foreclosure
441 Voting
463 Alien Detainee
or Defendant)
899 Administrative Procedure
230 Rent Lease & Ejectment
442 Employment
510 Motions to Vacate
Sentence
871 IRSThird Party 26
USC 7609
Act/Review or Appeal of
240 Torts to Land
443 Housing/
Accommodations
Other:
Agency Decision
245 Tort Product Liability
445 Amer. w/Disabilities -
530 General
IMMIGRATION
950 Constitutionality of State
Statutes
290 All Other Real Property
Employment
535 Death Penalty
462 Naturalization Application
446 Amer. w/Disabilities -
540 Mandamus & Other
465 Other Immigration
Other
550 Civil Rights
Actions
448 Education
555 Prison Condition
560 Civil Detainee
Conditions of
Confinement
V. ORIGIN
(Place an “X” in One Box Only)
Transferred from
another district
(specify)
6 Multidistrict
Litigation
Transfer
8
Multidistrict
Litigation
Direct
File
9
Remanded from
Appellate Court
1
Original
Proceeding
2
Removed
from State
Court
3
Re-filed
(See VI
below)
4
Reinstated
or
Reopened
5
7
Appeal to
District Judge
from Magistrate
Judgment
VI. RELATED/
RE-FILED CASE(S)
(See instructions): a) Re-filed Case YES
NO b) Related Cases YES NO
JUDGE:
DOCKET NUMBER:
VII. 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):
LENGTH OF TRIAL via days estimated (for both sides to try entire case)
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
ABOVE INFORMATION IS TRUE & CORRECT TO THE BEST OF MY KNOWLEDGE
DATE
SIGNATURE OF ATTORNEY OF RECORD
FOR OFFICE USE ONLY
RECEIPT #
AMOUNT
IFP
JUDGE
MAG JUDGE
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JS 44 (Rev. 06/17) FLSD Revised 06/01/2017
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 shee
t 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 sever
al 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. Nature of Suit. Place an "X" in the appropriate box. If there are multiple nature of suit codes associated with the case, pick the nature
of suit code that is most applicable. Click here for: Nature of Suit Code Descriptions
.
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.
Refiled (3) Attach copy of Order for Dismissal of Previous case. Also complete VI.
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 T
itle 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.
Remanded from Appellate Court. (8) Check this box if remanded from Appellate Court.
VI. Related/Refiled Cases. This section of the JS 44 is used to reference related pending cases or re-filed cases. Insert the docket numbers and the
corresponding judges name for such cases.
VII. 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
VIII. 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.