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Filing # 196461281 E-Filed 04/18/2024 09:59:39 AM
FORM 1.997. CIVIL COVER SHEET
The 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 shall 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 Florida Statutes section 25.075. (See
instructions for completion.)
1 CASE STYLE
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT,
IN AND FOR SEMINOLE COUNTY, FLORIDA
Plaintiff RICHARD RASMUSSEN Case #:
2024CA000705
Judge:
vs.
Defendant UNKNOWN DRIVER and
LILIA RODRIGUEZ
I. TYPE OF CASE (If the case fits more than one type of case, select the most definitive category.)
If the most descriptive label is a subcategory (is indented under a broader
category), place an x in both the main category and subcategory boxes.
Condominium Homestead residential foreclosure $0 - $50,000
Contracts and indebtedness Homestead residential foreclosure $50,001 - $249,999
0 Eminent domain 0 Homestead residential foreclosure $250,000 or more
” Auto negligence 0 Nonhomestead residential foreclosure
1 Negligence—other $0 - $50,000
1 Business governance 1 Nonhomestead residential foreclosure
1 Business torts $50,001 - $249,999
Environmental/Toxic tort 1 Nonhomestead residential foreclosure
0 Third party indemnification $250,000 or more
0 Construction defect 0 Other real property actions $0 - $50,000
Mass tort Other real property actions $50,001 - $249,999
Negligent security Other real property actions $250,000 or more
Nursing home negligence Professional malpractice
Premises liability—commercial Malpractice—business
Premises liability—residential Malpractice—medical
Products liability Malpractice—other professional
Real property/Mortgage foreclosure Other
Commercial foreclosure $0 - $50,000 Antitrust/Trade regulation.
Commercial foreclosure $50,001 - $249,999 Business transactions
Commercial foreclosure $250,000 or more Constitutional challenge—statute or ordinance
Constitutional challenge—proposed amendment 0 Libel/Slander
Corporate trusts. Li Shareholder derivative action
Discrimination—employment or other | Securities litigation
Insurance claims ] Trade secrets
Intellectual property | Trust litigation
Ill. REMEDIES SOUGHT (check all that apply):
4 monetary;
nonmonetary declaratory or injunctive relief;
punitive
IV. NUMBER OF CAUSES OF ACTION: [2]
(specify) COUNT I: NEGLIGENCE OF DEFENDANT UNKNOWN DRIVER.
COUNT II: VICARIOUS LIAILITY OF DEFENDANT LILIA RODRIGUEZ
IS THIS CASE A CLASS ACTION LAWSUIT?
ol yes
“no
VI. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?
4 no
1 yes If “yes,” list all related cases by name, case number, and court.
VIL. IS JURY TRIAL DEMANDED IN COMPLAINT?
7) yes
no
I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge and
belief.
Signature. Biel Novi Fla. Bar #41748
Attorney or party (Bar # if attorney
Brett Norvig 4/17/2024
(type or print name) Date
FORM 1.997. INSTRUCTIONS FOR
ATTORNEYS COMPLETING
CIVIL COVER SHEET
(A) Environmental/Toxic tort - all matters relating to
claims that violations of environmental regulatory
Plaintiff must file this cover sheet with first paperwork filed provisions or exposure to a chemical caused injury or
in the action or proceeding (except small claims cases or disease.
other county court cases, probate, or family cases). qd) Third party indemnification - all matters relating to
Domestic and juvenile cases should be accompanied by a liability transferred to a third party in a financial
completed Florida Family Law Rules of Procedure Form relationship.
12.928, Cover Sheet for Family Court Cases. Failure to file YD Construction defect - all civil lawsuits in which
a civil cover sheet in any civil case other than those damage or injury was allegedly caused by defects in the
excepted above may result in sanctions. construction of a structure.
(K) Mass tort - all matters relating to a civil action
1 Case Style. Enter the name of the court, the involving numerous plaintiffs against one or more
appropriate case number assigned at the time of filing of the defendants.
original complaint or petition, the name of the judge @) Negligent security - all matters involving injury to
med (if applicable), and the name (last, first, middle a person or property allegedly resulting from insufficient
initial) of plaintiff(s) and defendant(s). security,
(™) Nursing home negligence - all matters involving
Il. Type of Case. Place an “X” in the appropriate injury to a nursing home resident resulting from negligence
box. If the cause fits more than one type of case, select the of nursing home staff or facilities.
most definitive. If the most definitive label is a subcategory W) Premises liability—commercial - all matters
(indented under a broader category label), place an “X” in involving injury to a person or property allegedly resulting
the category and subcategory boxes. Definitions of the from a defect on the premises of a commercial property.
‘ases are provided below in the order they appear on the (O) Premises liability—residential - all matters
form. involving injury to a person or property allegedly resulting
from a defect on the premises of a residential property.
(A) Condominium - all civil lawsuits pursuant to (P) Products liability - all matters involving injury to a
Chapter 718, Florida Statutes, in which a condominium person or property allegedly resulting from the manufacture
association is a party. or sale of a defective product or from a failure to warn.
(B) Contracts and indebtedness - all contract actions Q Real property/Mortgage foreclosure - all matters
relating to promissory notes and other debts, including relating to the possession, title, or boundaries of real
those arising from the sale of goods, but excluding contract property.All matters involving foreclosures or sales of real
disputes involving condominium associations. property, including foreclosures associated with
© Eminent domain - all matters relating to the taking condominium associations or condominium units
of private property for public use, including inverse (R) Commercial foreclosure - all matters relating to the
condemnation by state agencies, political subdivisions, or termination of a business owner’s interest in commercial
public service corporations. property by a lender to gain title or force a sale to satisfy
(@) Auto negligence - all matters arising out of a the unpaid debt secured by the property. Check the category
party’s allegedly negligent operation of a motor vehicle. that includes the estimate of the amount in controversy of
() Negligence—other - all actions sounding in the claim (section 28.241, Florida Statutes).
negligence, including statutory claims for relief on account (S) Homestead residential foreclosure - all matters relating
of death or injury, that are not included in other main to the termination of a residential property owner’s interest
categories. by a lender to gain title or force a sale to satisfy the unpaid
() Business governance - all matters relating to the debt secured by the property where the property has been
management, administration, or control of a company. granted a homestead exemption. Check the category that
@ Business torts - all matters relating to liability for includes the estimate of the amount in controversy of the
economic loss allegedly caused by interference with claim (section 28.241, Florida Statutes)
economic or business relationships.
(1) Nonhomestead residential foreclosure - all matters (AG) Insurance claims - all matters relating to claims
relating to the termination of a residential property owner’s filed with an insurance company.
interest by a lender to gain title or force a sale to satisfy the (AH) Intellectual property - all matters relating to
unpaid debt secured by the property where the property has intangible rights protecting commercially valuable products
not been granted a homestead exemption. Check the of the human intellect.
category that includes the estimate of the amount in (AD Libel/Slander - all matters relating to written,
controversy of the claim (section 28.241, Florida Statutes). visual, oral, or aural defamation of character.
(WU) Other real property actions - all matters relating to (AD Shareholder derivative action - all matters relating
land, land improvements, or property rights not involving to actions by a corporation’s shareholders to protect and
commercial or residential foreclosure. Check the category benefit all shareholders against corporate management for
that includes the estimate of the amount in controversy of improper management.
the claim (section 28.241, Florida Statutes). (AK) Securities litigation - all matters relating to the
(Vv) Professional malpractice - all professional financial interest or instruments of a company or
malpractice lawsuits. corporation.
(Ww) Malpractice—business - all matters relating to a (AL) Trade secrets - all matters relating to a formula,
business’s or business person’s failure to exercise the process, device, or other business information that is kept
degree of care and skill that someone in the same line of confidential to maintain an advantage over competitors.
work would use under similar circumstances. (AM) Trust litigation - all civil matters involving
& Malpractice—medical - all matters relating to a guardianships, estates, or trusts and not appropriately filed
doctor’s failure to exercise the degree of care and skill that in probate proceedings.
a physician or surgeon of the same medical specialty would
use under similar circumstances.
@%) Malpractice—other professional - all matters I. Remedies Sought. Place an “X” in the appropriate
relating to negligence of those other than medical or box. If more than one remedy is sought in the complaint or
business professionals. petition, check all that apply.
(2) Other - all civil matters not included in other Iv. Number of Causes of Action. If the complaint or
categories. petition alleges more than one cause of action, note the
(AA) Antitrust/Trade regulation - all matters relating to number and the name of the cause of action.
unfair methods of competition or unfair or deceptive Vv. Class Action. Place an “X” in the appropriate box.
business acts or practices. VI. Related Cases. Place an “X” in the appropriate
(AB) Business transactions - all matters relating to box.
actions that affect financial or economic interests. VIL. Is Jury Trial Demanded In Complaint?
(AC) Constitutional challenge—statute or ordinance - a Check the appropriate box to indicate whether a jury trial is
challenge to a statute or ordinance, citing a violation of the being demanded in the complaint
Florida Constitution.
(AD) Constitutional challenge—proposed amendment - ATTORNEY OR PARTY SIGNATURE. Sign the civil
a challenge to a legislatively initiated proposed cover sheet. Print legibly the name of the person signing the
constitutional amendment, but excluding challenges to a civil cover sheet. Attorneys must include a Florida Bar
citizen-initiated _ proposed constitutional amendment number. Insert the date the civil cover sheet is signed.
because the Florida Supreme Court has direct jurisdiction of Signature is a certification that the filer has provided
such challenges. accurate information on the civil cover sheet.
(AE) Corporate trusts - all matters relating to the business
activities of financial services companies or banks acting in
a fiduciary capacity for investors.
(AF) Discrimination—employment or other - all matters
relating to discrimination, including employment, sex, race,
age, handicap, harassment, retaliation, or wages.
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Filing # 196461281 E-Filed 04/18/2024 09:59:39 AM FORM 1.997. CIVIL COVER SHEET The 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 shall 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 Florida Statutes section 25.075. (See instructions for completion.) 1 CASE STYLE IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR SEMINOLE COUNTY, FLORIDA Plaintiff RICHARD RASMUSSEN Case #: 2024CA000705 Judge: vs. Defendant UNKNOWN DRIVER and LILIA RODRIGUEZ I. TYPE OF CASE (If the case fits more than one type of case, select the most definitive category.) If the most descriptive label is a subcategory (is indented under a broader category), place an x in both the main category and subcategory boxes. Condominium Homestead residential foreclosure $0 - $50,000 Contracts and indebtedness Homestead residential foreclosure $50,001 - $249,999 0 Eminent domain 0 Homestead residential foreclosure $250,000 or more ” Auto negligence 0 Nonhomestead residential foreclosure 1 Negligence—other $0 - $50,000 1 Business governance 1 Nonhomestead residential foreclosure 1 Business torts $50,001 - $249,999 Environmental/Toxic tort 1 Nonhomestead residential foreclosure 0 Third party indemnification $250,000 or more 0 Construction defect 0 Other real property actions $0 - $50,000 Mass tort Other real property actions $50,001 - $249,999 Negligent security Other real property actions $250,000 or more Nursing home negligence Professional malpractice Premises liability—commercial Malpractice—business Premises liability—residential Malpractice—medical Products liability Malpractice—other professional Real property/Mortgage foreclosure Other Commercial foreclosure $0 - $50,000 Antitrust/Trade regulation. Commercial foreclosure $50,001 - $249,999 Business transactions Commercial foreclosure $250,000 or more Constitutional challenge—statute or ordinance Constitutional challenge—proposed amendment 0 Libel/Slander Corporate trusts. Li Shareholder derivative action Discrimination—employment or other | Securities litigation Insurance claims ] Trade secrets Intellectual property | Trust litigation Ill. REMEDIES SOUGHT (check all that apply): 4 monetary; nonmonetary declaratory or injunctive relief; punitive IV. NUMBER OF CAUSES OF ACTION: [2] (specify) COUNT I: NEGLIGENCE OF DEFENDANT UNKNOWN DRIVER. COUNT II: VICARIOUS LIAILITY OF DEFENDANT LILIA RODRIGUEZ IS THIS CASE A CLASS ACTION LAWSUIT? ol yes “no VI. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED? 4 no 1 yes If “yes,” list all related cases by name, case number, and court. VIL. IS JURY TRIAL DEMANDED IN COMPLAINT? 7) yes no I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge and belief. Signature. Biel Novi Fla. Bar #41748 Attorney or party (Bar # if attorney Brett Norvig 4/17/2024 (type or print name) Date FORM 1.997. INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET (A) Environmental/Toxic tort - all matters relating to claims that violations of environmental regulatory Plaintiff must file this cover sheet with first paperwork filed provisions or exposure to a chemical caused injury or in the action or proceeding (except small claims cases or disease. other county court cases, probate, or family cases). qd) Third party indemnification - all matters relating to Domestic and juvenile cases should be accompanied by a liability transferred to a third party in a financial completed Florida Family Law Rules of Procedure Form relationship. 12.928, Cover Sheet for Family Court Cases. Failure to file YD Construction defect - all civil lawsuits in which a civil cover sheet in any civil case other than those damage or injury was allegedly caused by defects in the excepted above may result in sanctions. construction of a structure. (K) Mass tort - all matters relating to a civil action 1 Case Style. Enter the name of the court, the involving numerous plaintiffs against one or more appropriate case number assigned at the time of filing of the defendants. original complaint or petition, the name of the judge @) Negligent security - all matters involving injury to med (if applicable), and the name (last, first, middle a person or property allegedly resulting from insufficient initial) of plaintiff(s) and defendant(s). security, (™) Nursing home negligence - all matters involving Il. Type of Case. Place an “X” in the appropriate injury to a nursing home resident resulting from negligence box. If the cause fits more than one type of case, select the of nursing home staff or facilities. most definitive. If the most definitive label is a subcategory W) Premises liability—commercial - all matters (indented under a broader category label), place an “X” in involving injury to a person or property allegedly resulting the category and subcategory boxes. Definitions of the from a defect on the premises of a commercial property. ‘ases are provided below in the order they appear on the (O) Premises liability—residential - all matters form. involving injury to a person or property allegedly resulting from a defect on the premises of a residential property. (A) Condominium - all civil lawsuits pursuant to (P) Products liability - all matters involving injury to a Chapter 718, Florida Statutes, in which a condominium person or property allegedly resulting from the manufacture association is a party. or sale of a defective product or from a failure to warn. (B) Contracts and indebtedness - all contract actions Q Real property/Mortgage foreclosure - all matters relating to promissory notes and other debts, including relating to the possession, title, or boundaries of real those arising from the sale of goods, but excluding contract property.All matters involving foreclosures or sales of real disputes involving condominium associations. property, including foreclosures associated with © Eminent domain - all matters relating to the taking condominium associations or condominium units of private property for public use, including inverse (R) Commercial foreclosure - all matters relating to the condemnation by state agencies, political subdivisions, or termination of a business owner’s interest in commercial public service corporations. property by a lender to gain title or force a sale to satisfy (@) Auto negligence - all matters arising out of a the unpaid debt secured by the property. Check the category party’s allegedly negligent operation of a motor vehicle. that includes the estimate of the amount in controversy of () Negligence—other - all actions sounding in the claim (section 28.241, Florida Statutes). negligence, including statutory claims for relief on account (S) Homestead residential foreclosure - all matters relating of death or injury, that are not included in other main to the termination of a residential property owner’s interest categories. by a lender to gain title or force a sale to satisfy the unpaid () Business governance - all matters relating to the debt secured by the property where the property has been management, administration, or control of a company. granted a homestead exemption. Check the category that @ Business torts - all matters relating to liability for includes the estimate of the amount in controversy of the economic loss allegedly caused by interference with claim (section 28.241, Florida Statutes) economic or business relationships. (1) Nonhomestead residential foreclosure - all matters (AG) Insurance claims - all matters relating to claims relating to the termination of a residential property owner’s filed with an insurance company. interest by a lender to gain title or force a sale to satisfy the (AH) Intellectual property - all matters relating to unpaid debt secured by the property where the property has intangible rights protecting commercially valuable products not been granted a homestead exemption. Check the of the human intellect. category that includes the estimate of the amount in (AD Libel/Slander - all matters relating to written, controversy of the claim (section 28.241, Florida Statutes). visual, oral, or aural defamation of character. (WU) Other real property actions - all matters relating to (AD Shareholder derivative action - all matters relating land, land improvements, or property rights not involving to actions by a corporation’s shareholders to protect and commercial or residential foreclosure. Check the category benefit all shareholders against corporate management for that includes the estimate of the amount in controversy of improper management. the claim (section 28.241, Florida Statutes). (AK) Securities litigation - all matters relating to the (Vv) Professional malpractice - all professional financial interest or instruments of a company or malpractice lawsuits. corporation. (Ww) Malpractice—business - all matters relating to a (AL) Trade secrets - all matters relating to a formula, business’s or business person’s failure to exercise the process, device, or other business information that is kept degree of care and skill that someone in the same line of confidential to maintain an advantage over competitors. work would use under similar circumstances. (AM) Trust litigation - all civil matters involving & Malpractice—medical - all matters relating to a guardianships, estates, or trusts and not appropriately filed doctor’s failure to exercise the degree of care and skill that in probate proceedings. a physician or surgeon of the same medical specialty would use under similar circumstances. @%) Malpractice—other professional - all matters I. Remedies Sought. Place an “X” in the appropriate relating to negligence of those other than medical or box. If more than one remedy is sought in the complaint or business professionals. petition, check all that apply. (2) Other - all civil matters not included in other Iv. Number of Causes of Action. If the complaint or categories. petition alleges more than one cause of action, note the (AA) Antitrust/Trade regulation - all matters relating to number and the name of the cause of action. unfair methods of competition or unfair or deceptive Vv. Class Action. Place an “X” in the appropriate box. business acts or practices. VI. Related Cases. Place an “X” in the appropriate (AB) Business transactions - all matters relating to box. actions that affect financial or economic interests. VIL. Is Jury Trial Demanded In Complaint? (AC) Constitutional challenge—statute or ordinance - a Check the appropriate box to indicate whether a jury trial is challenge to a statute or ordinance, citing a violation of the being demanded in the complaint Florida Constitution. (AD) Constitutional challenge—proposed amendment - ATTORNEY OR PARTY SIGNATURE. Sign the civil a challenge to a legislatively initiated proposed cover sheet. Print legibly the name of the person signing the constitutional amendment, but excluding challenges to a civil cover sheet. Attorneys must include a Florida Bar citizen-initiated _ proposed constitutional amendment number. Insert the date the civil cover sheet is signed. because the Florida Supreme Court has direct jurisdiction of Signature is a certification that the filer has provided such challenges. accurate information on the civil cover sheet. (AE) Corporate trusts - all matters relating to the business activities of financial services companies or banks acting in a fiduciary capacity for investors. (AF) Discrimination—employment or other - all matters relating to discrimination, including employment, sex, race, age, handicap, harassment, retaliation, or wages.