Miscellaneous: Foer, Samuel vs. Dhamma Dhara Vipassana Meditation Center

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                                                                              DOCKET NUMBER                       Trial Court of Massachusetts
                    CIVIL ACTION COVER SHEET                                                                       The Superior oeCourt                 an atai              z
                                                                                                                  COUNTY [Franklin Superior           Court mt(Greenfield) jor
                                       ‘Samuel any Foor                                                                      Dhanwa Dham Vipaasane Meditabon Certer
         ADDRESS                 F Country Drive                                                   ADDRESS.            586 Colrein Stetbuine RA. Shelourne Friis, MA O1S7O
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        Platnuff Attorney:       Pro Se: Serna! Fosr                                               Betendant Attorney: — Otwrrvise Ohare Viparsaia Nedation Cantor
         ADORERS           7 Counary Deve:                                                         ADDRESS.             Calvan Shelburne £4, Ghatbssne Fadis, MA G137
         7 County Orie                                                                                                                                       os
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         880.                                                                                       BBO.
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                                                      TYPE OF ACTION AND TRACK DESIGNATION (see instructions: section below)
                         CODE NO.                       TYPE OF ACTION (specify)               TRACK             HAS A JURY                CLAIM BEEN MADE?
                   Baz                        Employment Disonmination                                                                 (Cl ves
                                                                                                                                            4 no
         “i “Other”   please describe: This best descndes my case, although it is not exact, as the issue does not concer employment, but public accommodation.  eI
                                     ts there 2 claim under         G.L.c, 939A?                            is there # class action under Mass. R. Civ. P. 23?
                                         Ci ves        {no                                                      Cl] yes          ER)No.
                                                          STATEMENT              OF DABAGES PURSUANT TO.G.L..¢.212.834
         The following 1 @ full, temixed and detailed statementof the facts on which the undersigned plaintiff or plaintiff's counsel relies to determine money damages.
         For this form, disregard double or treble damage ctaims; indicate single damages only
a                                                                                          TORT.CLAIMS
2
         |A. Documented madiost expenses to date:
                   4. Total hospital expenses
                          2, Total doctor expenses                                                                                               ee reein         tneen
                          3 Tota! chiropractic expenses
                          4 Total physical therapy expenses
                          5. Total other expanses (describe below)                                                                                           ~       seins
                           l                                                                                         Subtotal (1-8),                         $0.00
              5. Gecumented lost wages and compensation
                                                      to date.
              Documented     property damages to date
              1D Reasonably anticipated fulure medical and hospital expenses                                                                                         ne
              E, Reasonably amicipated fost wages                                                                                                serine
              F. Other documented tec of damages (describe below)                                                                                                       seine
S
              Le                                                                                                     TOTAL IAF)
          G Briefly descr          ibe
                              plamtiff injury, inciuding the nature and extent of jury”
a                                                                                                                                                       has. |
          rhe plaintif has been the viciimn of racial discrimination by @ pisos of public actommadatons. oamsly the Vipassana Madiation Center The victin
               pisclucied from participating in.an event dua to the nature of his race alone            ws                                                   |
4                                                                                  CONTRACT CLAIMS
.               [] is action nckscen 0 ciaien invatving collecion of 3 debt incutted pursuant to 0 revolving cradit agreement Mass R. Cw P8.11a)
                   son &                                                 ‘Detaiied Description
                                                                                         ot Each Ciamn                                                               Asoount
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                   4
                                                                                                                                                    Total)


                                         ed X
                                      Plainti!.                      Samual Foer