On July 30, 2020 a
Miscellaneous
was filed
involving a dispute between
Commonwealth Of Massachusetts,
and
2003 Honda Odyssey Vin 5Fnrl18953B129798,
for Administrative Civil Actions
in the District Court of Worcester County.
Preview
eee
DOCKET NUMBER Trial Court of Massachusetts
CIVIL ACTION COVER SHEET The Superior Court
loot is
PLAINTIFF(S):
‘Worcester
ADDRESS:
i DEFENDANTS):
One 2003 Honda Odyssey Van
ATTORNEY: earing Vehicle Identification
APORESS: San. ADDRESS:
: Middle District Attorney’s Office
le
BBO: BBO# 225965
_
TYPE OF ACTION AND TRACK DESIGNATION (s
{ side)
CODE NO. _ TYPE OF ACTION (specity) TRACK HAS A JURY CLAIM BEEN MADE?
ROR ee aoe x (yes [JNo
*H "Other" please feseribe:
tegen personnel
are a claim une Lc. 93A7 is this a Mass.
R. Civ. 23?
el YES (J ves
STATEMENT
OF DAMAGES PURSUANT
TO G.L c. 242, § 3A
‘The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiffs counsel rekes to determine money damages.
For this form, disregard double or treble darnage claims; indicate single damages only.
(attach additional sheets as necessary)
|A. Documented medical expenses to date.
1. Total hospital expenses
2, Total doctor expenses
3. Total chiropractic expanses .
4. Total physical therapy expenses ..
5. Total other expenses (describe below)
Subtotal (A):
‘B. Documented fost wages and compensation to date
-C; Documented property damages to date
'D. Reasonably anticipated future medicat and hospital expenses
E, Reasonably anticipated lost wages
F, Other documented items of damages (describe below)
iG. Briefly describe plaintiffs injury, including the nature and extent of injury:
The Plaintiff is not seeking damages.
TOTAL [A-F):$
The Plaintiff, the Commonwealth of MA, is seeking equitable relief.
The Plaintiff is seeking forfeiture of the Defent -L. ¢. 94e Sec. 47
attach additional sheets as necessary)
This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a).
Provide a detailed description of claim(s)
TOTAL: $
Signature of Attorney/ Unrepresented Piaintiff: X Date:
RELATED ACTIONS: Please provide the case number, case name, and county of any related actions pending in the Superior Court.
ie i ie
CERTIFICATION PURSUANT TO SJC RULE 1:18
| hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC
Rule 1/18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the
[advantages and disadvantages of the various methods of dispute resolution.
‘Signature
Le
© of Attorney
of Record: X Sado
falta
Cie a hain. Date OM Raf? ch
Document Filed Date
July 30, 2020
Case Filing Date
July 30, 2020
Category
Administrative Civil Actions
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eee DOCKET NUMBER Trial Court of Massachusetts CIVIL ACTION COVER SHEET The Superior Court loot is PLAINTIFF(S): ‘Worcester ADDRESS: i DEFENDANTS): One 2003 Honda Odyssey Van ATTORNEY: earing Vehicle Identification APORESS: San. ADDRESS: : Middle District Attorney’s Office le BBO: BBO# 225965 _ TYPE OF ACTION AND TRACK DESIGNATION (s { side) CODE NO. _ TYPE OF ACTION (specity) TRACK HAS A JURY CLAIM BEEN MADE? ROR ee aoe x (yes [JNo *H "Other" please feseribe: tegen personnel are a claim une Lc. 93A7 is this a Mass. R. Civ. 23? el YES (J ves STATEMENT OF DAMAGES PURSUANT TO G.L c. 242, § 3A ‘The following is a full, itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiffs counsel rekes to determine money damages. For this form, disregard double or treble darnage claims; indicate single damages only. (attach additional sheets as necessary) |A. Documented medical expenses to date. 1. Total hospital expenses 2, Total doctor expenses 3. Total chiropractic expanses . 4. Total physical therapy expenses .. 5. Total other expenses (describe below) Subtotal (A): ‘B. Documented fost wages and compensation to date -C; Documented property damages to date 'D. Reasonably anticipated future medicat and hospital expenses E, Reasonably anticipated lost wages F, Other documented items of damages (describe below) iG. Briefly describe plaintiffs injury, including the nature and extent of injury: The Plaintiff is not seeking damages. TOTAL [A-F):$ The Plaintiff, the Commonwealth of MA, is seeking equitable relief. The Plaintiff is seeking forfeiture of the Defent -L. ¢. 94e Sec. 47 attach additional sheets as necessary) This action includes a claim involving collection of a debt incurred pursuant to a revolving credit agreement. Mass. R. Civ. P. 8.1(a). Provide a detailed description of claim(s) TOTAL: $ Signature of Attorney/ Unrepresented Piaintiff: X Date: RELATED ACTIONS: Please provide the case number, case name, and county of any related actions pending in the Superior Court. ie i ie CERTIFICATION PURSUANT TO SJC RULE 1:18 | hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC Rule 1/18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the [advantages and disadvantages of the various methods of dispute resolution. ‘Signature Le © of Attorney of Record: X Sado falta Cie a hain. Date OM Raf? ch