CIVIL COVER SHEET

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                          Filing # 152050001 E-Filed 06/23/2022 11:34:55 AM

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 with the Clerk of Court for the purpose of reporting uniform data pursuant
to section 25.075, Florida Statutes. (See instructions for completion.)

I. CASE STYLE

IN THE CIRCUIT/COUNTY COURT OF THE TWELFTH JUDICIAL CIRCUIT,
IN AND FOR SARASOTA COUNTY, FLORIDA

SHAUN WILLIAMS, LISA M WILLIAMS

Plaintiff Case #
Judge
VS.
TOWER HILL SIGNATURE INSURANCE COMPANY
Defendant

II. AMOUNT OF CLAIM

Please indicate the estimated amount of the claim, rounded to the nearest dollar. The estimated amount of
the claim is requested for data collection and clerical processing purposes only. The amount of the claim
shall not be used for any other purpose.

$8,000 or less
$8,001 - $30,000
BJ $30,001- $50,000
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