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IA

Case 1:09-cv-01186-HTW Document 1-6 Filed 05/04/09 Page 1 of 1

s 44 ( R cv 12/07)

- - CV - 118 .6

CIVIL COVER SH EET 1

O9

JS 44 c i v il c ov er sheet and the i nfo rma tion conta i n ed herein ne ither repl ace n or suppl ement the fil ing and se rvice ofpleadin gs or other p apers as required by law, excep t as p rov ided
by l ocal rules o f co urt . T h is form , approved by the Judicial Conference of the United States in Sep tember 1974 , i s required for the u se oft he C l er k of Court for the purpose of initiating
the c ivil docket sheet. ( SEE INSTRUCTIONS O N THE RE VERSE OF THE FORM .)

1 . (a) PLAINTIFFS

DEFENDANTS

d 4IrlE'5 11t Vti. i"k G*1M .c~

.~
County of Residence of First Li s ted Defendant

(b) County of Re s idence of First Listed Plaintiff


(EXCEPT IN U .S . PLAINTIFF CASES)

r- U LroN

(IN U .S. PLAINTIFF CASES ONLY}


NOTE : INLAND CONDEMNATION CASES, USE THE LOCATION OF THE .
LAND INVOLVED .

(G) attorney ' s (Fi

Name, Address, and Telephon IYu

Attorneys (If Known)

pp.~N
G t~MA~ L ,
Elk t' rSwEq AO- gTCHf o r 44 Y
L B AS I S OF JURI S DICTION

III . C ITIZENS HIP OF PRI NC IPAL PARTIES(Place an `x" in owe sox

(Place an "X" in One Box Only )

( For D iversity
O l U . S . G overnment fU 3 Fede ral Que stion
plaintiff
~
( U .S . Government Not a Party)

O 2 U . S , G overnment
0 4 Diver sity
Defenda nt (Indicate Citizen

en -r
O 110 Insurance
O 120 Marine

PERSONAL INJURY
0 310 Airplane

2 10 Land Condemnation
220 Foreclosure
230 R e nt Lease & Ejectment
240 To rts to Land
245 Tort Pr oduct Liability
2 90 All Other Real Property

~, 2

2 Inco rporated and Principal Place


of Bus iness In Another S t ate

C i tizen or Subje ct of a

0 3

D 6 O 6

F o reign Nation

C7

PERSONAL INJURY
362 Personal Injury Med. Malpractice

0 365 Personal Injury


Product Liability
0 368 Asbestos Personal
Injury Product
Liability
PERS ONA L PROPE RTY

O 370 Other Fraud


0 371 Truth in Lending
0 380 Other Personal
Property Damage

O 441 Voting

385 Property Damage


Product Liability

5 1 0 Motions to Vacate
Sentence
Habeas Corpus:
536 General
535 Death Penalty
540 Mandamus & Other
550 Civil Rights
555 Prison Condition

0
0

442 Emp loyment


443 Housing/
Accommodations
0 444 Welfare
0 445 Amer . wlDisabilities
Empl oyment
O 446 Amer. w/Disabilities
Other

0 6l0 Agriculture
0 620 Other Food & Drug
0 625 Drug Related Seizure
of Property 21 USC 881
0 630 Liquor Laws
0 640 R.R. & Truck
0 650 Airline Regs .
0 660 Occupational
Safety/Health
O 690 Other

Act
720 Labor/Mgmt. Re lations
730 Labor/Mgmt.Reporting
& Disclosure Act
740 Railway Labor Act
790 Other Labor litigation
791 Empl . Ret. In c,
Security Ac t

422 Appeal 28 U SC 1 58
423 Withdrawal
28 USC 157

830 Patent

840 Trademark

861 HIA (1395th


862 Bl ac k Lung ( 923)
863 Diwc/DIww (405(g))
864 SSID Title XVI
865 RS1 f405(01
870 Taxes ( U. S . Pl aintiff
or Defendant)
871 IRS-Third Party
26 USC 7609

463 Habeas Corpus Alien Detainee


465 Other Immigration
Actions

ra nsfer red fro m


Cl 4 Reinsta ted o r Q g T
173 6 Multidistrict
Reopened another district Litigation
lsnecifvl
C ite the U. S . C ivi l Statute und er whigo you a re filing (Do not cite jurisdictional statute s unless diversity) :

VI . CAUSE OF ACTION B rief description of cause :

T c g, - r

: JUDGE

DOCKET NUMB E R
~0%1

(,0o0-1'

org

~
AMO UNT

APPLYING

~ 40/S

IFP

to Di stri ct
from

',

(See instructions)

SIGNATURE OF RNEY OF RE
4EV7
00

CH ECK YES o nl y i f d emanded in complaint :


JURY DEMAND:
O Yes O No

V III . R E LATED CASE(S)

RECEIPT #

lo p

V II . REQ UESTED IN 0 C HECK IF THIS IS A CLASS ACTION DEMANDS


UNDE R F . R .C . P. 23
C OMPLAI NT :

DATE

0 400 State Re apport ionment


0 4 10 An titr ust
O 4 30 Batiks and Banki ng
O 450 Co mmerce
O 4 60 Dep ortati on
O 4 70 Racketeer Influenced and
Corrupt Organi za tions
0 480 Consumer Credit
0 490 C able/Sat 7'V
0 810 Sel ective Service
0 8 5 0 Securi ties/Comm o dities/
Exchange
O 8 7 5 Customer C hallenge
1 2 USC 34 1 0
0 890 Other Statutory Actions
O 891 A gricul tural Acts
0 892 Economi c Stabi liza t io n Act
Q 8 93 E nvi ronmental Matters
Q 8 94 Energy Allo cation Act
17 895 F re e dom of Inf ormation
Act
Q 90DAppeal of Fee Determin ati on
Under Equal Access
to J usti c e
0 950 Constitutionality of
State Statu tes

(Pl ace an `X" in O ne Box O nly)


Q 3 Reman de d from
O 2 Removed from
S tate Court
App ellate Co urt

IF AN Y

:i s~

0 440 Other Civil Rights

V . ORI G IN
I Ori gin a l
Proc ee d ing

for Plaintiff
Only) and One B ox for Defe nd ant)
DEF
PTF
DEF
Incorporated or Princ ipal Pl ace
0 4 O 4
Busine ss In This S tat e

C i tizen of Another State


ship of Parties in Item III )

O ! 30 Mil ler Ac t D 315 Airplane Product


O E 40 Neg ot i ab le In strument
Liability
O t 5 0 R e c ov ery o fOverpeyment D 320 Assault, Libel &
& Enforcement ofJudgment Slander
0 151 Medicare Act
0 330 Federal Employer s'
O 1 52 R ec overy of Defaulted
Liability
Student Loans
0 34 0 Marine
( Excl. Veterans) 0 345 Marine Product
D 153 R ecovery of Overpayment Liability
of Veteran ' s Benefits
0 350 Motor Veh i cle
0 160 Stockholders' Suit s
0 355 Motor V ehicle
~ l90 Other Contract
Product Liab i lity
~] I95 Contract Product Liability 0 360 Other Personal
0 196 Franchi se
Injury
C3
D
O
O
0
0

Citizen of This State

Cases
PTF
O 1 ~ 1
~~ of

J U DGE

1010

MAG. JUD GE

7s