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eFiled Date: 04/25/2024, Accepted: 04/25/2024 01:51 PM
Filing # 196993337 E-Filed 04/25/2024 01:01:56 PM
ne Civil Cover sheet and the intormation 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 plaintiffor petitioner for the use of the Clerk
of the Court for the purpose of reporting judicial workload data pursuant to Florida Statues section 25.075. (See
instructions for completion).
I CASE STYLE
IN THE COUNTY COURT IN AND FOR CLAY COUNTY, FLORIDA
Plaintiff Case #:
NATIONWIDE CAC, LLC
A Member of the Nationwide Family of Companies
vs. Judge:
Defendants
CYNTHIA MITCHELL,
Th. AMOUNT OF CLAIM
Please indicate the estimated amount of the claim, rounded to the nearest dollar. $13,783.16.
TIL. 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.
CIRCUIT CIVIL
oO Condominium
o Contracts and indebtedness
o Eminent domain
0 Auto negligence
a Negligence ~— other
Business governance
Business torts
Environmental/Toxic tort
0 Third party indemnification
Construction defect
Mass tort
Negligent security
Nursing home negligence
Premises liability - commercial
a Premises liability — residential
Products liability
| Real Property/Mortgage Foreclosure
0 Commercial foreclosure
aq Homestead residential foreclosure
oO Non-homestead residential foreclosure
Oo Other real property actions
Professional malpractice
O Malpractice — business
Malpractice — medical
0 Malpractice — other professional
eFiled Date: 04/25/2024, Accepted: 04/25/2024 01:51 PM
Other
Antitrust/Trade Regulation
Business Transaction
Constitutional challenge-statute or ordinance
o Constitutional challenge-proposed amendment
Corporate Trusts
Discrimination-employment or other
Insurance claims
Intellectual property
Libel/Slander
Shareholder derivative action
Securities litigation
Trade secrets
Trust litigation
COUNTY CIVIL
Xx Civil
0 Replevins
Oo Evictions
o Other Civil (none-monetary)
IV REMEDIES SOUGHT (check all that apply):
X Monetary;
O Non-monetary declaratory or injunctive relief;
O Punitive
NUMBER OF CAUSES OF ACTION: (specify)
(2) Contract and Equity
VI. IS THIS CASE A CLASS ACTION LAWSUIT?
0 Yes
X No
vil. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?
X No
O Yes - If "yes list all related cases by name, case number and court:
Vid. IS JURY TRIAL DEMANDED IN COMPLAINT?
O Yes
X No
I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge
eFiled Date: 04/25/2024, Accepted: 04/25/2024 01:51 PM
and belief, and that I have read and will comply with the requirements of Florida Rule of Judicial
Administration 2.425,
Signature: /s/ Drew Beinhaker Fla. Bar # 0163538
Attorney or Party (if attorney)
Drew Beinhaker Date: April 22, 2024
Type or print name
FORM 1.997, INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET
Plaintiff must file this cover sheet with first paperwork filed in the action or proceeding (except small
claims cases, probate, or family cases). Domestic and juvenile cases should be accompanied by a
completed Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases.
Failure to file a civil cover sheet in any civil case other than those excepted above may result in
sanctions.
I. Case Style. Enter the name of the court, the appropriate case number assigned at the time of filing of
the original complaint or petition, the name of the judge assigned (if applicable), and the name (last,
first, middle initial) of plaintiff(s) and defendant(s).
If. Amount of Claim. Enter the estimated amount of the claim, rounded to the nearest dollar.
Theestimated amount of the claim is requested for data collection and clerical processing purposes and
is not considered dispositive of the claim,
ILL. Type of Case. Place an “X” in the appropriate box. If the cause fits more than one type of case,
selectthe most definitive. If the most definitive label is a subcategory (indented under a broader category
label, place an “X” in the category and subcategory boxes. Definitions of the cases are provided below
in the order they appear on the form.
Circuit vil
(A) Condominium - all civil lawsuits pursuant to Chapter 718, Florida Statutes, in which a
condominium association is a party.
(B) Contracts and indebtedness - all contract actions relating to promissory notes and other debts,
including those arising from the sale of goods, but excluding contract disputes involving condominium
associations.
(C) Eminent domain - all matters relating to the taking of private property for public use, including
inverse condemnation by state agencies, political subdivisions, or public service corporations.
(D) Auto negligence - all matters arising out of a party’s allegedly negligent operation of a motor
vehicle,
(E) Negligence—other - all actions sounding in negligence, including statutory claims for relief on
account of death or injury, that are not included in other main categories.
(F) Business governance - all matters relating to the management, administration, or control of a
company.
(G) Business torts - all matters relating to liability for economic loss allegedly caused by interference
with economic or business relationships.
(H) Environmental/Toxic tort - all matiers relating to claims that violations of environmental regulatory
provisions or exposure to a chemical caused injury or disease.
(1) Third party indemnification - all matters relating to liability transferred to a third party in a financial
relationship.
eFiled Date: 04/25/2024, Accepted: 04/25/2024 01:51 PM
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(J) Construction defect - all civil lawsuits in which damage or injury was allegedly caused by defects in
the construction of a structure.
(IX) Mass tort - all matters relating to a civil action involving numerous plaintiffs against one or more
defendants.
(L) Negligent security - all matters involving injury to a person or property allegedly resulting from
insufficient security.
(M) Nursing home negligence - all matters involving injury to a nursing home resident resulting from
negligence of nursing home staff or facilities.
(N) Premises liability—commercial - all matters involving injury to a person or property allegedly
resulting from a defect on the premises of a commercial property.
(O) Premises liability—residential - all matters involving injury to a person or property allegedly
resulting from a defect on the premises of a residential property.
(P) Products liability - all matters involving injury to a person or property allegedly resulting from the
manufacture or sale of a defective product or from a failure to warn.
(Q) Real property/Mortgage foreclosure - all matters relating to the possession, title, or boundaries of
real property, All matters involving foreclosures or sales of real property, including foreclosures
associated with condominium associations or condominium units. (The amount of claim specified in
Section II, of the form determines the filing fee pursuant to section 28.241, Florida Statutes.)
(R) Commercial foreclosure - all matters relating to the termination of a business owner’s interest in
commercial property by a lender to gain title or force a sale to satisfy the unpaid debt secured by the
property.
(S) Homestead residential foreclosure ~ all matters relating to the termination of a residential property
owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the property
where the property has been granted a homestead exemption.
(T) Non-homestead residential foreclosure - all matters relating to the termination of a residential
property owner’s interest by a lender to gain title or force a sale to satisfy the unpaid debt secured by the
property where the property has not been granted a homestead exemption.
(U) Other real property actions - all matters relating to land, land improvements, or property rights not
involving commercial or residential foreclosure.
(V) Professional malpractice - all professional malpractice lawsuits.
(W) Malpractice—business - all matters relating to a business’s or business person’s failure to exercise
the degree of care and skill that someone in the same line of work would use under similar
circumstances.
(X) Malpractice—medical - all matters relating to a doctor’s failure to exercise the degree of care and
skill that a physician or surgeon of the same medical specialty would use under similar circumstances.
(Y) Malpractice—other professional - all matters relating to negligence of those other than medical or
business professionals.
(Z) Other - all civil matters not included in other categories.
(AA) Antitrust/Trade regulation - all matters relating to unfair methods of competition or unfair or
deceptive busines: ts or practices.
(AB) Business nsactions - all matters relating to actions that affect financial or economic interests.
(AC) Constitutional challenge—statute or ordinance — a challenge to a statute or ordinance, citing a
violation of the Florida Constitution.
(AD) Constitutional challenge—proposed amendment — a challenge to a legislatively initiated proposed
constitutional amendment, but excluding challenges to a citizen-initiated proposed constitutional
amendment because the Florida Supreme Court has direct jurisdiction of such challenges.
(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
eFiled Date: 04/25/2024, Accepted: 04/25/2024 01:51 PM
(AG) Insurance claims - all matters relating to claims filed with an insurance company.
(AH) Intellectual property - all matters relating to intangible rights protecting commercially valuable
products ofthe human intellect.
(AI) Libel/Slander - all matters relating to written, visual, oral, or aural defamation ofcharacter.
(AJ) Shareholder derivative action - all matters relating to actions by a corporation's shareholders to
protect and benefit all shareholders against corporate management for improper management.
(AK) Securities litigation - all matters relating to the financial interest or instruments of a company or
corporation.
(AL) Trade secrets - all matters relating to a formula, process, device, or other business information that
is kept confidential to maintain an advantage over competitors.
(AM) Trust litigation — all civil matters involving guardianships, estates, or trusts and not appropriately
filed in probate proceedings.
County Civil
(AN) Civil — all matters involving claims ranging from $8,001 through $30,000 in damages, exclusive
of interest, costs, and attorney fees.
(AO) Replevins — all lawsuits pursuant to Chapter 78, Florida Statutes, involving claims up to $30,000.
(AP) Evictions — all matters involving the recovery of possession of leased land or rental property by
process of law.
(AQ) Other Civil (non-monetary) — includes all other non-monetary county civil matters that were not
described in the other county civil categories.
IV. Remedies Sought. Place an “X” in the appropriate box. If more than one remedy is sought in the
complaint or petition, check all that apply.
V. Number of Causes of Action. If the complaint or petition alleges more than one cause of action,
note the number and the name of the cause of action.
VI. Class Action. Place an “X” in the appropriate box.
VII. Related Cases. Place an “X” in the appropriate box.
VII. Is Jury Trial Demanded In Complaint? Check the appropriate box to indicate whether a jury
trial is being demanded in the complaint
ATTORNEY OR PARTY SIGNATURE. Sign the civil cover sheet. Print legibly the name of the person
signing the civil cover sheet. Attorneys must include a Florida Bar number. Insert the date the civil
cover sheet is signed. Signature is a certification that the filer has provided accurate information on the
civil cover sheet.