Miscellaneous: CROFT, KELLI

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                                35-2021-CA-001217-AXXX-XX

    Filing # 129863718 E-Filed 06/30/2021 08:20:09 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 FIFTH JUDICIAL CIRCUIT,
                                              IN AND FOR LAKE COUNTY, FLORIDA

             Kelli and Nicholas J. Croft
             Plaintiff                                                                 Case #
                                                                                       Judge
             vs.
            United Property & Casualty Insurance Company
             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.

             O     $8,000 or less
             O $8,001 -       $30,000
               $30,001-        $50,000
             © $50,001-        $75,000
             0 $75,001       - $100,000
             O over $100,000.00

                      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 on both the main category and subcategory lines.




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FILED: LAKE COUNTY, GARY J. COONEY, CLERK, 07/01/2021 03:14:29 PM.
CIRCUIT CIVIL

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

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

COUNTY CIVIL

O Small Claims up to $8,000
O Civil
O Real property/Mortgage foreclosure
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O 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 0 No Xi

         Iv.        REMEDIES SOUGHT (check all that apply):
         & Monetary;
         0 Nonmonetary declaratory or injunctive relief;
         O Punitive

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

               41

         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.

         Vill.      IS JURY TRIAL DEMANDED             IN COMPLAINT?
                    & yes
                    Ono

 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/ Jabari Akil Bennett                        Fla. Bar # 110725
                 Attorney or party                                       (Bar # if attorney)

Jabari Akil Bennett                                06/30/2021
  (type or print name)                             Date




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