Case 9:17-cv-80728-DMM Document 1-1 Entered on FLSD Docket 06/13/2017 Page 1 of 1

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(b) CountyofResidenceofFirstListedPlaintiff Palm Beach CountyofResi

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VI. RELATED/ (Seeinstructions):a)Re-filedCase LYES d NO b)RelatedCases Z YES n NO
RE-FILED cAsE(s) JtmGE:Middlebrooks oocxx'
rNVMBER:17-cv-80723
CitetheU.S.CivilSututeunderwhichyouarefilingandW riteaBriefStatementofCause (D0notcf/e./xriçd
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vII. CAUSE OF ACTION 15U.S.C.jj 1681-1681x.
,15U.S.C.jj 1692-1692p,
.15 U.S.C.j44
LENGTH OF TRIALvia daysestimated(forbothsidestotr.yentirecase)
VIII.REQUESTED IN IZICHECKIFTHISISACLASSACTION DEMAND $ C
CO M PLAINT: UNDER F.R.C.P 23 HECK YESonlyifdemandedi
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ABOVE INFORM ATION ISTRUE & CORRECT TO THE BEST OF M Y KNOW LEDGE '
DATE SIGNATURE OFAT OF RECORD
June 13,2017
FOR OFFICE USE ONLY
RECEIPT # AMOUNT JUDGE MAG JUDGE