arrow left
arrow right
  • Kathleen Kacvinsky on behalf of Philip Myers vs. Woburn High School et al Other Equity Action document preview
  • Kathleen Kacvinsky on behalf of Philip Myers vs. Woburn High School et al Other Equity Action document preview
						
                                

Preview

DOCKET NUMBER Trial Court of Massachusetts dye 144s CIVIL ACTION COVER SHEET The Superior Court PLAINTIFF(S): VtWeen |Zocvinslay on Behay € COUNTY ADDRESS: of Phila Myers! BY Moufleunw Rf DEFENDANT(S): Wilourn Wigh Schoo } Wibuya, MA S)COL EA Wiauire~ ATTORNEY: Dar GLanen ADDRESS: ADDRESS: EE Ma valé Ave \wabucn, mA Oita) BBO: . TYPE OF ACTION AND TRACK DESIGNATION (see reverse side) TYPE OF ACTION (specify) HAS A JURY CLAIM BEEN MADE? c CODE NO. D6 Odie Bgyity Action OO ves [I] No “If "Other" please describe: Is there a claim under G.L. c. 93A? Is this a class action under Mass. R. Civ. P. 23? YES N STATEMENT OF DAMAGES PURSUANT TO G.L. c. 212, § 3A. The following is a full, Itemized and detailed statement of the facts on which the undersigned plaintif or plaintiff's counsel relies to determine money damages. |For this form, disregard double or treble damage claims; indicate single damages only. ‘ORT CLAIMS {attach additional shee! necessary) A. Documented medical expenses to date: 1. Total hospital expenses 2. Total doctor expenses: 3. Total chiropractic exp CLERK ee 4. Total physical therapy expenst Hibs Soy 5. Total other expenses (describe below) 1 20% al (A): B, Documented fost wages and compensation to date \C. Documented property damages to date ... 1D. Reasonably anticipated future medical and hospital expenses Eeigh E, Reasonably anticipated lost wages ... F. Other documented items of damages (Geseribe Pelow) |G. Briefly describe plaintiff's injury, including the nature and extent of Injury: TOTAL (A-F):$ CONTRACT CLAIM: {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 Plaintiff: X | L, Allao~ ( (_. Date: 4 |3ifay IRELATED ACTIONS: Please provide the case number, case name, and county of any related actions pending in the Superior Court. 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 of Attorney of Record: X Date: