Fill and Sign the Service of Process Us Marshals Form

UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET CV-71 (07/05)CIVIL COVER SHEETPage 1 of 2 I (a) PLAINTIFFS (Check box if you are representing yourself G) (b)County of Residence of First Listed Plaintiff (Except in U.S. Plaintiff Cases):DEFENDANTS County of Residence of First Listed Defendant (In U.S. Plaintiff Cases Only): (c) Attorneys (Firm Name, Address and Telephone Number. If you are representing yourself, provide same.)Attorneys (If Known) II. BASIS OF JURISDICTION (Place an X in one box only.)III. CITIZENSHIP OF PRINCIPAL PARTIES - For Diversity Cases Only (Place an X in one box for plaintiff and one for defendant.) G 1 U.S. Government Plaintiff G 3 Federal Question (U.S. Government Not a Party) Citizen of This StatePTF G 1DEF G 1 Incorporated or Principal Place of Business in this StatePTF G 4DEF G 4 G 2 U.S. Government Defendant G 4 Diversity (Indicate Citizenship of Parties in Item III) Citizen of Another State G 2 G 2 Incorporated and Principal Place of Business in Another State G 5 G 5 Citizen or Subject of a Foreign Country G 3 G 3 Foreign Nation G 6 G 6 IV. ORIGIN (Place an X in one box only.) G 1Original Proceeding G 2 Removed from State Court G 3 Remanded from Appellate Court G 4 Reinstated or Reopened G 5 Transferred from another district (specify): G 6 Multi- District Litigation G 7 Appeal to District Judge from Magistrate Judge V. REQUESTED IN COMPLAINT:JURY DEMAND: G Yes G No (Check ‘Yes’ only if demanded in complaint.) CLASS ACTION under F.R.C.P. 23: G Yes G No G MONEY DEMANDED IN COMPLAINT: $ 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 Do not cite jurisdictional statutes unless diversity.)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.) OTHER STATUTES G 400 State ReapportionmentG 410 AntitrustG 430 Banks and BankingG 450 Commerce/ICC Rates/etc. G 460 DeportationG 470 Racketeer Influenced and Corrupt Organizations G 480 Consumer CreditG 490 Cable/Sat TVG 810 Selective ServiceG 850 Securities/Commodities /Exchange G 875 Customer Challenge 12 USC 3410 G 890 Other Statutory ActionsG 891 Agricultural ActG 892 Economic Stabilization Act G 893 Environmental MattersG 894 Energy Allocation ActG 895 Freedom of Info. ActG 900 Appeal of Fee Determi- nation Under Equal Access to Justice G 950 Constitutionality of State StatutesCONTRACT G 110 InsuranceG 120 MarineG 130 Miller ActG 140 Negotiable InstrumentG 150 Recovery of Overpayment & Enforcement of Judgment G 151 Medicare ActG 152 Recovery of Defaulted Student Loan (Excl. Veterans) G 153 Recovery of Overpayment of Veteran’s Benefits G 160 Stockholders’ SuitsG 190 Other ContractG 195 Contract Product Liability G 196 Franchise REAL PROPERTY G 210 Land CondemnationG 220 ForeclosureG 230 Rent Lease & EjectmentG 240 Torts to LandG 245 Tort Product LiabilityG 290 All Other Real PropertyTORTS PERSONAL INJURY G 310 AirplaneG 315 Airplane Product Liability G 320 Assault, Libel & Slander G 330 Fed. Employers’ Liability G 340 MarineG 345 Marine Product Liability G 350 Motor VehicleG 355 Motor Vehicle Product Liability G 360 Other Personal Injury G 362 Personal Injury- Med Malpractice G 365 Personal Injury- Product Liability G 368 Asbestos Personal Injury Product LiabilityTORTS PERSONAL PROPERTY G 370 Other FraudG 371 Truth in LendingG 380 Other Personal Property Damage G 385 Property Damage Product Liability BANKRUPTCY G 422 Appeal 28 USC 158 G 423 Withdrawal 28 USC 157 CIVIL RIGHTS G 441 VotingG 442 EmploymentG 443 Housing/Acco- mmodations G 444 WelfareG 445 American with Disabilities - Employment G 446 American with Disabilities - Other G 440 Other Civil RightsPRISONER PETITIONS G 510 Motions to Vacate Sentence Habeas Corpus G 530 GeneralG 535 Death PenaltyG 540 Mandamus/ Other G 550 Civil RightsG 555 Prison Condition FORFEITURE / PENALTY G 610 AgricultureG 620 Other Food & Drug G 625 Drug Related Seizure of Property 21 USC 881 G 630 Liquor LawsG 640 R.R. & TruckG 650 Airline RegsG 660 Occupational Safety /Health G 690 OtherLABOR G 710 Fair Labor Standards Act G 720 Labor/Mgmt. Relations G 730 Labor/Mgmt. Reporting & Disclosure Act G 740 Railway Labor ActG 790 Other Labor Litigation G 791 Empl. Ret. Inc. Security Act PROPERTY RIGHTS G 820 CopyrightsG 830 PatentG 840 Trademark SOCIAL SECURITY G 861 HIA (1395ff)G 862 Black Lung (923)G 863 DIWC/DIWW (405(g)) G 864 SSID Title XVIG 865 RSI (405(g)) FEDERAL TAX SUITS G 870 Taxes (U.S. Plaintiff or Defendant) G 871 IRS-Third Party 26 USC 7609 VIII(a). IDENTICAL CASES: Has this action been previously filed and dismissed, remanded or closed? G No G Yes If yes, list case number(s): FOR OFFICE USE ONLY: Case Number: . UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA CIVIL COVER SHEET CV-71 (07/05)CIVIL COVER SHEETPage 2 of 2 AFTER COMPLETING THE FRONT SIDE OF FORM CV-71, COMPLETE THE INFORMATION REQUESTED BELOW. VIII(b). RELATED CASES: Have any cases been previously filed that are related to the present case? G No G 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) G A. Arise from the same or closely related transactions, happenings, or events; or G B. Call for determination of the same or substantially related or similar questions of law and fact; or G C. For other reasons would entail substantial duplication of labor if heard by different judges; or G 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: List the California County, or State if other than California, in which EACH named plaintiff resides (Use an additional sheet if necessary) G Check here if the U.S. government, its agencies or employees is a named plaintiff. List the California County, or State if other than California, in which EACH named defendant resides. (Use an additional sheet if necessary). G Check here if the U.S. government, its agencies or employees is a named defendant. List the California County, or State if other than California, in which EACH claim arose. (Use an additional sheet if necessary) Note: In land condemnation cases, use the location of the tract of land involved. X. SIGNATURE OF ATTORNEY (OR PRO PER): 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 Substantive Statement of Cause of Action 861 HIA 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)) 862 BL 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) 863 DIWC 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)) 863 DIWW 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)) 864 SSID All claims for supplemental security income payments based upon disability filed under Title 16 of the Social Security Act, as amended. 865 RSI All claims for retirement (old age) and survivors benefits under Title 2 of the Social Security Act, as amended. (42 U.S.C. (g))