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                                Filing # 97319573 E-Filed 10/15/2019 04:03:28 PM

Case Number: CACE-19-021349 Division: 05

FORM 1.997. CIVIL COVER SHEET

The civil cover sheet and the information contained in it neither replace nor supplement the filing and service of pleadings
or other documents as required by law. This form must be filed by the plaintiff or petitioner for the use of the Clerk of
Court for the purpose of reporting judicial workload data pursuant to section 25.075, Florida Statutes. (See instructions for
completion.)

 

CASE STYLE

IN THE CIRCUIT COURT OF THE SEVENTEENTH

JUDICIAL CIRCUIT,

IN AND FOR BROWARD COUNTY, FLORIDA

 

Case No.:
Judge:
Rafael Govin
Plaintiff
vs.
Defendant
I TYPE OF CASE
O _ Non-homestead residential foreclosure
O Condominium $250,00 or more :
O Contracts and indebtedness © Other real property actions $0 - $50,000
Eminent domain O Other real property actions $50,001 - $249,999
OD Auto negligence O Other real property actions $250,000 or more
O Negligence — other |
© Business governance Professional malpractice ;
O___Business torts O Malpractice — business
Ds Environmental/Toxic tort a Malpractice — medical :
Os Third party indemnification O Malpractice — other professional
Construction defect QO Other : /
Os Mass tort O  Antitrust/Trade Regulation
go Negligent security O Business Transaction
a Nursing home negligence O Circuit Civil - Not Applicable
O Premises liability — commercial Oo Sanaa tl challenge-statute or
a la ie ordinance
o vrodkete babiy a 1 Constitutional challenge-proposed
= amendment
O Real Property/Mortgage foreclosure dg Corporate Trusts
1 Commercial foreclosure $0 - $50,000 a Discrimination-employment or other
O Commercial foreclosure $50,001 - $249,999 g Insurance claims
O Commercial foreclosure $250,000 or more Intellectual property
© Homestead residential foreclosure $0 — 50,000 a Libel/Slander
oO isc residential foreclosure $50,001 - a Shareholder derivative action
: identi O Securities litigatic
O__ Homestead residential foreclosure $250,000 or = eee eee
more O sTrade secrets
 __ Non-homestead residential foreclosure $0 - O Trust litigation
$50,000
© Non-homestead residential foreclosure

$50,001 - $249,999

 

*** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 10/15/2019 04:03:26 PM.****COMPLEX BUSINESS COURT

This action is appropriate for assignment to Complex Business Court as delineated and mandated by the
Administrative Order. Yes 0 No &

th. REMEDIES SOUGHT (check all that apply):
Monetary;
UO Non-monetary declaratory or injunctive relief;
OQ Punitive

IV. NUMBER OF CAUSES OF ACTION: (_)
(Specify)

1

Vv. IS THIS CASE A CLASS ACTION LAWSUIT?
O Yes
& No

Vi. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?
& No
O Yes - If “yes” list all related cases by name, case number and court:

Vil. IS JURY TRIAL DEMANDED IN COMPLAINT?
& Yes
O No

 

| CERTIFY that the information | have provided in this cover sheet is accurate to the best of my knowledge and belief, and
that | have read and will comply with the requirements of Florida Rule of Judicial Administration 2.425.

Signature s/ Daniel Harwin FL Bar No.: 682446
Attorney or party (Bar number, if attorney)

Daniel Harwin 10/15/2019
(Type or print name) Date