Miscellaneous: DEACON, LEROY vs. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA

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                                Filing # 129337654 E-Filed 06/23/2021 12:52:07 PM

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 COURT OF THE TWENTIETH JUDICIAL CIRCUIT,
IN AND FOR CHARLOTTE COUNTY, FLORIDA

Leroy Deacon

 

Plaintiff Case # _21000730CA
Judge
vs.
American Integrity Insurance Company of Florida
Defendant

 

Il. 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.

1 $8,000 or less

C1 $8,001 - $30,000
1 $30,001- $50,000
1 $50,001- $75,000
$75,001 - $100,000
Oi over $100,000.00

Ill. TYPEOFCASE __ (Ifthe 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 on both the main category and subcategory lines.CIRCUIT CIVIL

© Condominium
Contracts and indebtedness
CO Eminent domain
Oc Auto negligence
O Negligence—other
CO Business governance
O Business torts
0 Environmental/Toxic tort
O Third party indemnification
O Construction defect
O Mass tort
O Negligent security
O Nursing home negligence
O Premises liability—commercial
O Premises liability—residential
O Products liability
© Real Property/Mortgage foreclosure
O Commercial foreclosure
© Homestead residential foreclosure
Ci Non-homestead residential foreclosure
O Other real property actions

OProfessional malpractice
0 Malpractice—business
O Malpractice—medical
0 Malpractice—other professional
O Other
O Antitrust/Trade regulation
CO Business transactions
O Constitutional challenge—statute or ordinance
O Constitutional challenge—proposed amendment
CO Corporate trusts
O Discrimination—employment or other
CO Insurance claims
C Intellectual property
0 Libel/Slander
O Shareholder derivative action
O Securities litigation
0 Trade secrets
O Trust litigation

COUNTY CIVIL

O Small Claims up to $8,000
O Civil
CO Real property/Mortgage foreclosureO Replevins
O Evictions

O Residential Evictions

O Non-residential Evictions
O Other civil (non-monetary)

COMPLEX BUSINESS COURT

This action is appropriate for assignment to Complex Business Court as delineated and mandated by the
Administrative Order. Yes 1] No &

IV. REMEDIES SOUGHT (check all that apply):
& Monetary;

OC Nonmonetary declaratory or injunctive relief;

O Punitive

Vv. NUMBER OF CAUSES OF ACTION: [ ]
(Specify)

1

VI. IS THIS CASE A CLASS ACTION LAWSUIT?
O yes
no

VII. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?
& no
O yes If “yes,” list all related cases by name, case number, and court.

VUI. IS JURY TRIAL DEMANDED IN COMPLAINT?
yes
O no

ICERTIFY that the information I have provided in this cover sheet is accurate to the best of
my knowledge and belief, and that I have read and will comply with the requirements of
Florida Rule of Judicial Administration 2.425.

Signature: s/ Alejandro Sasieta Fla. Bar # 109573
Attorney or party (Bar # if attorney)

Alejandro Sasieta 06/23/2021
(type or print name) Date