waar one TST ‘Sheppard v. Long, et al. CIVIL CASE COVER SHEET ADDENDUM AND. STATEMENT OF LOCATION (CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO COURTHOUSE LOCATION) This form is required pursuant to Local Rule 2.3 n all new civil case filings In the Los Angelos Superior Court, Herm, Check te type of hearng andl he estimated length of hearing expected fortis case: JURYTRIALAES CLASSACTION? YES LITEDCASE? YES TMEESTIMATEDFOR TRL? wounsioars Item tl Indicate the correct district and courthouse location (4 steps ~ If you checked “Limited Case’, skip to Item Il}, Pg. 4): ‘Step 1: Attor first completing the Civil Case Cover Sheet form, find the main Civil Case Cover Sheet heading for your ase in the le margin below, and, tothe rghlin Cohumn A, the Civil Case Cover Sheet case type you selected. Step 2: Check ane Superior Cour type of action in Column B below which best describes the nature ofthis case. Step 3: In Column C, circle the reason for the court location choice that applies to the type of action you have ‘checked. For any exceplion to the court location, see Local Rule 2.3, SBIR eenmmsermtncmmencrmtces flare py smec ce SSE Be AE sone care 5 LEE ern oiaearte om ERE Noe otha eges STIIE 6 Eeiivetresmasites 11, Mandatory Fung Location (ul Case) Step 4: Fillin the information requested on page 4 in Item I; compte tem IV. Sign the decaration, A 8 C Apacatio ‘Ch Case Cover iat Type of Aion Reasons S00 Slop 3 Galego Ho. (hack oniyone) ‘above ‘to (22) _AT100 Molr Venice Person nuniPropety Pamagenvrongtl Death | 1.244 35 | Dae | = ; Be] perme |e oe ones, [tt Sy, om areeenoy é Dacia (23) (D._A7270 tnteronatafleton of motional Distees wa E 1D A7220 Other Parsonlinuryropary OamogetWrenght Death LacW 109 Rov 9715) CIVIL CASE COVER SHEET ADDENDUM Tocal Rule 23 ASC Approved 03-04 AND STATEMENT OF LOCATION Page tof 4_ cama . TA es horse om al ov tet aC rti——SS acount cee : soe ne) SlUr———C“‘rs—sr_C—isézt§$ BE ‘Gi Righls (08) (G AG005 Civ Rights/Disesminaion oon i ee uaa iy Fost) © Ao Fraud ro ete 128 = é AAO tae pect haa Prter Neies 8 il a hLFFrt~—CCssC | a Cr ta 4g [emai Tominton 8 [AST Vig Tortan TEs i 1 Alize Obe Empey Gone Ge aa S| onmenpeynet z 15) | maton Labor Conmtsiona Appa ‘0 ee —™—E co Breachet Congecd Werenty | 5 nsoo9 consaciWarely Breach Seler Pal (no reudnepgence) 28 {not insurance) OD A6019 Negligent Breach of ContracyWarranty (no fraud) ae 1D A6028 Otter Breach of ContraclWarranty (not fraud or negigence) _ DAU? Cation Ge Sas Pa Baan Cotetor C1 6012 Cer rman Neots Case nant = Q__ A8034 Collections Case-Purchased Debt (Charged Olf Consumer Debt 6.6.11 Dl ee ee) 1288 AE Creston eae overcame) |. Ato Te orcs teas a eee _s=s = [| PRRERSBEG™ Jo arse cnnon OoerCordamein Nimo opocn, 2 2 | wewiaevaones [a ate wong evconcoe = g 'D ASOI8 Moigage Force 28 onerRestPrpoya) | ABD Out The za © AsH0 Cereal Prope clench, dosent. aecesce) |? 6 | RRS weeemeenrenemnems (ee 4 | iowenpeeset | paca ol arrestee ape erworatonaon [ase 3 [7 Bisons [oscar tna oan tet roncnue 2a Se a LACIV 109 (Rev 2/15) CIVIL CASE COVER SHEET ADDENDUM Local Rule 2.3 UASC Approved 03-04 AND STATEMENT OF LOCATION Page 2 of 4‘Sheppard v. Long, etal. Ease ae) eS Crores hv Case Coversheet : Stevo He. (€eck nto) = : resetroteure (3) [0 Asi08 2.6 Pen reArbicaton (1) | C2 ABIIS Palilono CampelContmwocate Wbivaon 2.6 i caeaaeceroms 7 1 Wet ottanasta(02) | a AB4S2 Wal- Mandan on Lined Cout Cove Mair 2 3 8159 Wil- Oar Lited Cout Case Review 2 ‘her JuseatRevew (39) | ABH60 Ofer ir dude Review 2.8 ag [Ainge Repanten 3) [OA Aide Roun 1.2.8 | ceranetenvetea 9 | A000? Comneton deta aan 5 ins ving Mas Tot a a, 3 ane (0 16008 Gls inv Me 4.248 & [7 Sees igaion) | A5005 Seiten natn Coe aaa i on ee 12.88. E Insurance Coverage Ciains | cy 4G014 Insurance CoveragelSubopatin (ompexcaso ony) 1.2.5.8 TD AGIA Shor Sate Judanent 2.8 ee 1 AS160 Abstract of smo 2.0. z extrcenent 10 AS107 Conession ofudgrent ran domes ators) 28. 4 3 of Judgment (20) 1D AB140 Admicisicative Agency Award (nol unpaid taxes) 2.8, 3 1D ABt4PattnyCartcat or Ey of dudgrent on Unplé Tax 2.8 (0 Ast12 Ober Enercoment of odgnent Case 2.8.9, Taco TD ABOSS Recketesing (C0) Caso 2.8 gz a {0 AGO Dectaony Reet Ony 4.2.8 g ‘othor Complsinis | A6040 trjunctve ete! Only (not domestomerassient) 2.8. s {Hot Spectied Above) (42) } 96011 Other Commarciat Complaint Case (non-tortinon-complox) Wn 2B 7 Z_ AG0O0 Other Cival Complaint (non-torvnon-complen) 1428 PanresripCoraaton” Tey Aatt9 Partnership and Corporat Goveranco Case 2.0, © 0124 Cha Horsemen 2.2.9 ge 2. A812 Wotploe Horstman, 2.8.8, FE | ommranensyug [0 A124 Searbaperso. nts nan Cs 2.3,0 BE | spececanoy es) | Aote0 exctonconent 2 gs © A8110 Paton for Change ofNme 2.7, {2 AG170 Poten or Resa ome Clima 2,944.0 1 A800 Cine Ch Poston 2.9 ‘aw 100 Rew an8) CIVIL CASE COVER SHEET ADDENDUM Tocal Rule 23 ‘LASC Approved 03-04 AND STATEMENT OF LOCATION Page 30f4wre Co ‘Sheppard v. Long, otal. {temill, Statement of Location: Enter the address of the accident, partys residence or place of business, performance, or other circumstance indicated in Item I, Step 3 on Page 1, as the proper reason for fling in the court tocation you selected. REASON: hack th appropriate boxos forthe qumbors shown |i si, fof Nowa Bid Uindor Column € forthe typo of atl tat you hove selected for | Nowak Um 90650 this cose 11.U2,03,64.08.06.U7. 18.0 9,210.11 Nerwalk cn | soss0 Hem 1V, Declaration of Assignmont:| dectare under penalty of perjury undar the laws ofthe State of California thatthe forogong is true ‘and coreet and thal the above-enliled mattor is properly fled for assignment to the Stanley Mosk courthouse in the Central __ istrict of the Superior Court of California, County of Los Angeles [Code Civ. Proc., § 982 ¢1 $0q., and Local Rule 2.3, subd(a). Dated ApH 22,2019 PLEASE HAVE THE FOLLOWING ITEMS COMPLETED AND READY TO BE FILED IN ORDER TO PROPERLY ‘COMMENCE YOUR NEW COURT CASE: 1. Original Complaint or Pettion. 2. Iffilng a Complaint, a completed Summons form for lasuance by the Clerk. 3. Civil Case Cover Sheet, Judicial Council form CM-010. 4 Gl Cate Cover Sheet Adandun and Statement of Local fom, LAGI 108, LASE Approved 08-04 (Rev Payment in ful of the fling fee, unless fees have been waived. A signed order appointing the Guardian ad Litem, Judicial Council form ClV-010, i the plaintif or petitioner is @ ‘minor under 18 years of age will be required by Court in order to issue a summons, 7. Additional copies of documents to be conformed by the Clerk. Copies of the cover sheet and this addendum ‘must be served along with the summons and complaint, or other iiiating pleading in the case, LACIV 109 Rev a6) CIVIL CASE COVER SHEET ADDENDUM {Local Rule 23 {ASC Approved 03-04 AND STATEMENT OF LOCATION Page 4 of4