Miscellaneous: GOVERNMENT EMPLOYEES INSURANCE COMPANY ASO TRACEY DIXSON,

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                                35-2018-CA-000477-AXXX-XX

Filing # 69254583 E-Filed 03/14/2018 01:26:06 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 for the use of the Clerk of
Court for the purpose of reporting judicial workload data pursuant to section 25.075, Florida Statutes. (See instructions for
completion.)

CASE STYLE

IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT,
IN AND FOR LAKE COUNTY, FLORIDA

Case No.:
Judge:
Government Employees Insurance Company
Plaintiff
vs.
James Tioime
Defendant
I. TYPE OF CASE
OG _Non-homestead residential foreclosure
1 Condominium $250,00 or more
Contracts and indebtedness © Other real property actions $0 - $50,000
O Eminent domain Other real property actions $50,001 - $249,999
®& Auto negligence O Other real property actions $250,000 or more
O Negligence - other
Ol Business governance © Professional malpractice
11 _ Business torts 1 Malpractice — business
O  Environmental/Toxic tort OQ Malpractice—medical
Os Third party indemnification a Malpractice — other professional
O Construction defect OD Other .
O Mass tort 0 sAntitrust/Trade Regulation
ad Negligent security © Business Transaction
oO Nursing home negligence O  Gircuit Civil - Not Applicable
a Premises liability — commercial O Constitutional challenge-statute or
1 Premises liability — residential ordinance
C1 Products liability © Constitutional challenge-proposed
oO amendment
O Real Property/Mortgage foreclosure oO Corporate Trusts
OQ Commercial foreclosure $0 - $50,000 Ol _ Discrimin ation-employment or other
O Commercial foreclosure $50,001 - $249,999 og Insurance claims
O Commercial foreclosure $250,000 or more CO Intellectual property
1 Homestead residential foreclosure $0 — 50,000 oa Libe/Slander
ao oor’ residential foreclosure $50,001 - DD _— Shareholder derivative action
© Homestead residential foreclosure $250,000 or O Securities tigation
more O sTrade secrets
0D _ Non-homestead residential foreclosure $0 - Q Trust litigation
$50,000
© _ Non-homestead residential foreclosure

$50,001 - $249,999

FILED: LAKE COUNTY, NEIL KELLY, CLERK, 03/15/2018 11:22:58 AMCOMPLEX BUSINESS COURT

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

M. REMEDIES SOUGHT (check all that apply):
& Monetary;
0 Non-monetary declaratory or injunctive relief;
O Punitive
WV. NUMBER OF CAUSES OF ACTION: (_)
(Specify)

1

Vv. IS THIS CASE A CLASS ACTION LAWSUIT?
O Yes
& No

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

Vil. IS JURY TRIAL DEMANDED IN COMPLAINT?
O Yes
& No

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

Signature s/ Gary S Rabin FL Bar No.: 261051
Attorney or party (Bar number, if attorney)

Gary S Rabin 03/14/2018
(Type or print name) Date