UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET
I. (a) PLAINTIFFS ( Check box if you are representing yourself )
DEFENDANTS ( Check box if you are representing yourself )
(b)Attorneys (Firm Name, Address and Telephone Number. If you are representing yourself, provide same.)
(b)Attorneys (Firm Name, Address and Telephone Number. If you are representing yourself, provide same.)
II. BASIS OF JURISDICTION (Place an X in one box only.) |
III. CITIZENSHIP OF PRINCIPAL PARTIES-For Diversity Cases Only |
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(Place an X in one box for plaintiff and one for defendant) |
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1. U.S. Government |
3. Federal Question (U.S. |
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PTF |
DEF |
Incorporated or Principal Place |
PTF |
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DEF |
Citizen of This State |
1 |
1 |
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4 |
4 |
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of Business in this State |
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Plaintiff |
Government Not a Party) |
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Citizen of Another State |
2 |
2 |
Incorporated and Principal Place |
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5 |
5 |
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of Business in Another State |
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2. U.S. Government |
4. Diversity (Indicate Citizenship |
Citizen or Subject of a |
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Defendant |
3 |
3 |
Foreign Nation |
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6 |
6 |
of Parties in Item III) |
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Foreign Country |
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IV. ORIGIN (Place an X in one box only.) |
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5. Transferred from Another |
6. Multi- |
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1. Original |
2. Removed from |
3. Remanded from |
4. Reinstated or |
District (Specify) |
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District |
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Litigation |
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State Court |
Appellate Court |
Reopened |
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Proceeding |
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V. REQUESTED IN COMPLAINT: JURY DEMAND: |
Yes |
No (Check "Yes" only if demanded in complaint.) |
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CLASS ACTION under F.R.Cv.P. 23: |
Yes |
No |
MONEY DEMANDED IN COMPLAINT: $ |
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VI. 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.)
VII. NATURE OF SUIT (Place an X in one box only).
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OTHER STATUTES |
CONTRACT |
REAL PROPERTY CONT. |
IMMIGRATION |
PRISONER PETITIONS |
PROPERTY RIGHTS |
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375 False Claims Act |
110 Insurance |
240 Torts to Land |
462 Naturalization |
Habeas Corpus: |
820 Copyrights |
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245 Tort Product |
Application |
463 Alien Detainee |
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400 State |
120 Marine |
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830 Patent |
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Liability |
465 Other |
510 Motions to Vacate |
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Reapportionment |
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Immigration Actions |
Sentence |
840 Trademark |
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410 Antitrust |
130 Miller Act |
290 All Other Real |
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530 General |
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430 Banks and Banking |
140 Negotiable |
Property |
TORTS |
SOCIAL SECURITY |
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TORTS |
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535 Death Penalty |
861 HIA (1395ff) |
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Instrument |
PERSONAL PROPERTY |
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450 Commerce/ICC |
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150 Recovery of |
PERSONAL INJURY |
370 Other Fraud |
Other: |
862 Black Lung (923) |
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Rates/Etc. |
310 Airplane |
540 Mandamus/Other |
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Overpayment & |
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371 Truth in Lending |
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460 Deportation |
Enforcement of |
315 Airplane |
550 Civil Rights |
863 DIWC/DIWW (405 (g)) |
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Judgment |
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470 Racketeer Influ- |
Product Liability |
380 Other Personal |
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864 SSID Title XVI |
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555 Prison Condition |
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enced & Corrupt Org. |
151 Medicare Act |
320 Assault, Libel & |
Property Damage |
560 Civil Detainee |
865 RSI (405 (g)) |
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480 Consumer Credit |
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Slander |
385 Property Damage |
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152 Recovery of |
330 Fed. Employers' |
Conditions of |
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Defaulted Student |
Product Liability |
Confinement |
FEDERAL TAX SUITS |
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Liability |
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490 Cable/Sat TV |
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Loan (Excl. Vet.) |
BANKRUPTCY |
FORFEITURE/PENALTY |
870 Taxes (U.S. Plaintiff or |
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340 Marine |
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850 Securities/Com- |
153 Recovery of |
422 Appeal 28 |
625 Drug Related |
Defendant) |
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345 Marine Product |
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modities/Exchange |
USC 158 |
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Overpayment of |
Seizure of Property 21 |
871 IRS-Third Party 26 USC |
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Liability |
423 Withdrawal 28 |
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890 Other Statutory |
Vet. Benefits |
USC 881 |
7609 |
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Actions |
160 Stockholders' |
350 Motor Vehicle |
USC 157 |
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CIVIL RIGHTS |
690 Other |
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355 Motor Vehicle |
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891 Agricultural Acts |
Suits |
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440 Other Civil Rights |
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Product Liability |
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893 Environmental |
190 Other |
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LABOR |
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360 Other Personal |
441 Voting |
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Matters |
Contract |
710 Fair Labor Standards |
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Injury |
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895 Freedom of Info. |
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Act |
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195 Contract |
362 Personal Injury- |
442 Employment |
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Act |
720 Labor/Mgmt. |
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Product Liability |
Med Malpratice |
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896 Arbitration |
196 Franchise |
365 Personal Injury- |
443 Housing/ |
Relations |
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Accomodations |
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Product Liability |
740 Railway Labor Act |
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899 Admin. Procedures |
REAL PROPERTY |
445 American with |
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367 Health Care/ |
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210 Land |
751 Family and Medical |
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Disabilities- |
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Act/Review of Appeal of |
Pharmaceutical |
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Condemnation |
Employment |
Leave Act |
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Agency Decision |
Personal Injury |
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790 Other Labor |
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220 Foreclosure |
Product Liability |
446 American with |
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Litigation |
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950 Constitutionality of |
230 Rent Lease & |
368 Asbestos |
Disabilities-Other |
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791 Employee Ret. Inc. |
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State Statutes |
Personal Injury |
448 Education |
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Ejectment |
Security Act |
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Product Liability |
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FOR OFFICE USE ONLY: Case Number:
AFTER COMPLETING PAGE 1 OF FORM CV-71, COMPLETE THE INFORMATION REQUESTED ON PAGE 2.
CV-71 (02/13) |
CIVIL COVER SHEET |
Page 1 of 2 |
UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA
CIVIL COVER SHEET
VIII(a). IDENTICAL CASES: Has this action been previously filed in this court and dismissed, remanded or closed? |
NO |
YES |
If yes, list case number(s): |
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VIII(b). RELATED CASES: Have any cases been previously filed in this court that are related to the present case? |
NO |
YES |
If yes, list case number(s):
Civil cases are deemed related if a previously filed case and the present case:
(Check all boxes that apply) |
A. Arise from the same or closely related transactions, happenings, or events; or |
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B. Call for determination of the same or substantially related or similar questions of law and fact; or |
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C. For other reasons would entail substantial duplication of labor if heard by different judges; or |
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D. Involve the same patent, trademark or copyright, and one of the factors identified above in a, b or c also is present. |
IX. VENUE: (When completing the following information, use an additional sheet if necessary.)
(a)List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH named plaintiff resides.
Check here if the government, its agencies or employees is a named plaintiff. If this box is checked, go to item (b).
County in this District:*
California County outside of this District; State, if other than California; or Foreign Country
(b)List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH named defendant resides.
Check here if the government, its agencies or employees is a named defendant. If this box is checked, go to item (c).
County in this District:*
California County outside of this District; State, if other than California; or Foreign Country
(c)List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH claim arose.
NOTE: In land condemnation cases, use the location of the tract of land involved.
County in this District:*
California County outside of this District; State, if other than California; or Foreign Country
*Los Angeles, Orange, San Bernardino, Riverside, Ventura, Santa Barbara, or San Luis Obispo Counties
Note: In land condemnation cases, use the location of the tract of land involved
X. SIGNATURE OF ATTORNEY (OR SELF-REPRESENTED LITIGANT): |
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DATE: |
Notice to Counsel/Parties: The CV-71 (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. This form, approved by the Judicial Conference of the United States in September 1974, is required pursuant to Local Rule 3-1 is not filed but is used by the Clerk of the Court for the purpose of statistics, venue and initiating the civil docket sheet. (For more detailed instructions, see separate instructions sheet).
Key to Statistical codes relating to Social Security Cases:
Nature of Suit Code |
Abbreviation |
861 |
HIA |
862 |
BL |
863 |
DIWC |
863 |
DIWW |
864 |
SSID |
865 |
RSI |
Substantive Statement of Cause of Action
All claims for health insurance benefits (Medicare) under Title 18, Part A, of the Social Security Act, as amended. Also, include claims by hospitals, skilled nursing facilities, etc., for certification as providers of services under the program. (42 U.S.C. 1935FF(b))
All claims for "Black Lung" benefits under Title 4, Part B, of the Federal Coal Mine Health and Safety Act of 1969. (30 U.S.C. 923)
All claims filed by insured workers for disability insurance benefits under Title 2 of the Social Security Act, as amended; plus all claims filed for child's insurance benefits based on disability. (42 U.S.C. 405 (g))
All claims filed for widows or widowers insurance benefits based on disability under Title 2 of the Social Security Act, as amended. (42 U.S.C. 405 (g))
All claims for supplemental security income payments based upon disability filed under Title 16 of the Social Security Act, as amended.
All claims for retirement (old age) and survivors benefits under Title 2 of the Social Security Act, as amended. (42 U.S.C. 405 (g))
CV-71 (02/13) |
CIVIL COVER SHEET |
Page 2 of 2 |