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FOR THE EASTERN DISTRICT OF PENNSYLVANIA — DESIGNATION FORM to be used by counsel to indicate the category of the case for the purpose of assignment to appropriate calendar.
UNITED STATES DISTRICT COURT
Address ofPlaintJff: CI6 intJff: Address ofDefendant:
. f 6^ Lx , M A
Place of Accident, Incident or Transaction: (Use Reverse Side For Additional Space) Does this civil action involve a nongovernmental corporate party with any parent corporation and any publicly held corporation owning 10% or more of its stock? (Attach iwo copies of the Disclosure Statemenl Form in accordance with Fed.R.Civ.P. 7.1(a)) Does this case involve multidistrict litigation possibilities? RELATEDCASE, IF ANY: Ciisc Niiutlx-i: Judge Date Terminated: Yesd Yesn NiJSft
Civil cases are deemed related when yes is answered to any of the following questions: I . Is this case related to property included in an earlier numbered suit pending or within one year previously terminated action in this court? YesX NoD 2. Does this case involve the same issue of fact or grow out ol" the same transaction as a prior suit pending or within one year previously terminated action in this court? 3. Does this case involve the validity or infringement of a patent already in suit or any earlier numbered case pending or within one year previously terminated action in this court? YesD
4. Is this case a second or successive habeas corpus, social security appeal, or pro se civil rights case filed by the same individual?
CIVIL: (Place • in ONE CATEGORY ONLY) A. Federal Question Cases: B. Diversity Jurisdiction Cases:
1. n Indemnity Contract, Marine Contract, and Alt Other Contracts 2. a FELA 3. a Jones Act-Personal Injury 4. n Antitrust 5. D Patent 6. n Labor-Management Relations 7. P Civil Rights 8. D Habeas Corpus 9. a Securities Act(s) Cases 10. D Social Security Review Cases 1 1. X^AIl other Federal Question Cases (Please specify) fW*y fjjU-l-
1. a Insurance Contract and Other Contracts 2. n Airplane Personal Injury 3. D Assault, Defamation 4. O Marine Personal Injury 5. D Motor Vehicle Personal Injury 6. n Other Personal Injury (Please specify) 7. a Products Liability 8. D Products Liability—Asbestos 9. D All other Diversity Cases
(Check Appropriate Category) , counsel of record do hereby certify: and belief, the damages recoverable in this civil action case exceed the sum of a Pursuant to Local Civil Rule/3.C Section 3(cX2), that to the best of my kn $ 150,000.00 exclusive of interest and costs; X. Relief other than monetary damages is sought. DATE:
Ajj«fney-at-Law Attorney I.D.# enovo will be a trial by jury only if there has been compliance wilh F.R.C.P. 38. endim me year previously terminated action in this court
I certify that, to my knowledge, the within case is not related to any case except as noted above. _ DATE:
CIV. 609 (5/2012)