Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv-00814-GMS
JS 44 Reverse (Rev. 12/96)

Document 1-2

Filed 11/28/2005

Page 1 of 2

INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS-44
Authority For Civil Cover Sheet
The JS-44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint filed. The attorney filing a case should complete the form as follows: I. (a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both name and title. (b.) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the "defendant" is the location of the tract of land involved.) (c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting in this section "(see attachment)". II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires that jurisdictions be shown in pleadings. Place an "X" in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below. United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States, are included here. United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box. Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be marked. Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the different parties must be checked. (See Section III below; federal question actions take precedence over diversity cases.) III. Residence (citizenship) of Principal Parties. This section of the JS-44 is to be completed if diversity of citizenship was indicated above. Mark this section for each principal party. IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section IV below, is sufficient to enable the deputy clerk or the statistical clerks in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the most definitive. V. Origin. Place an "X" in one of the seven boxes.

Original Proceedings. (1) Cases which originate in the United States district courts. Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition for removal is granted, check this box. Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date. Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date. Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a) Do not use this for within district transfers or multidistrict litigation transfers. Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box is checked, do not check (5) above. Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judge's decision. VI. VII. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Rule 23, F.R.Cv.P.

Demand. In this space enter the dollar amount (in thousands of dollars) being demanded or indicate other demand such as a preliminary injunction. Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded. VIII. Related Cases. This section of the JS-44 is used to reference related pending cases if any. If there are related pending cases, insert the docket numbers and the corresponding judge names for such cases. Date and Attorney Signature. Date and sign the civil cover sheet.

Case 1:05-cv-00814-GMS
JS 44 (Rev. 3/99)

CIVIL COVER SHEET

Document 1-2

Filed 11/28/2005

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The JS-44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM.)

I. (a) PLAINTIFFS

Jennifer Nyselius
(b) County of Residence of First Listed Plaintiff New Castle (EXCEPT IN U.S. PLAINTIFF CASES)

DEFENDANTS Wyeth Pharmaceuticals Inc. Long Term Disability Plan Policy Metropolitan Life Insurance Company
County of Residence of First Listed New Castle (IN U.S. PLAINTIFF CASES ONLY)
NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE LAND INVOLVED.

(c)

Attorney's (Firm Name, Address, and Telephone Number)

Attorneys (If Known)

II. BASIS OF JURISDICTION
1 U.S. Government
Plaintiff

Michael J. Goodrick 18B Trolley Square Wilmington, DE 19806 (302) 778-5360
(Place an "X" in One Box Only)

Unknown
III. CITIZENSHIP OF PRINCIPAL PARTIES(Place an "X" in One Box for Plaintiff
(For Diversity Cases Only)
and One Box for Defendant) DEF

3 Federal Question
(U.S. Government Not a Party)

Citizen of This State

1

1

Incorporated or Principal Place of Business In This State

4

DEF

4 5 6

2 U.S. Government
Defendant

4 Diversity
(Indicate Citizenship of Parties in Item III)

Citizen of Another State 2

2 3

Incorporated and Principal Place 5 of Business In Another State Foreign Nation

Citizen or Subject of a Foreign Country

3

6

IV. NATURE OF SUIT
CONTRACT
110 Insurance 120 Marine 130 Miller Act 140 Negotiable Instrument 150 Recovery of Overpayment & Enforcement of Judgment 151 Medicare Act 152 Recovery of Defaulted Student Loans (Excl. Veterans) 153 Recovery of Overpayment of Veteran's Benefits 160 Stockholders' Suits 190 Other Contract 195 Contract Product Liability

(Place an "X" in One Box Only)
TORTS
PERSON AL INJURY 310 Airplane 315 Airplane Product Liability 320 Assault, Libel & Slander 330 Federal Employers' Liability 340 Marine 345 Marine Product Liability 350 Motor Vehicle 355 Motor Vehicle Product Liability 360 Other Personal Injury PERSONAL IN JUR Y 362 Personal Injury-- Med. Malpractice 365 Personal Injury -- Product Liability 368 Asbestos Personal Injury Product Liability PERSON AL PR OPERTY 370 Other Fraud 371 Truth in Lending 380 Other Personal Property Damage 385 Property Damage Product Liability



FORFEITURE/PENALTY BANKRUPTCY 610 Agriculture 422 Appeal 28 USC 158 620 Other Food & Drug 625 Drug Related Seizure 423 Withdrawal
of Property 21 USC 630 Liquor Laws 640 R.R. & Truck 650 Airline Regs. 660 Occupational Safety/Health 690 Other 28 USC 157

PROPERTY RIGHTS 820 Copyrights 830 Patent 840 Trademark SOCIAL SECURITY

OTHER STATUTES 400 State Reapportionment 410 Antitrust 430 Banks and Banking 450 Commerce/ICC Rates/etc. 460 Deportation 470 Racketeer Influenced and 810 Selective Service 850 Securities/Commodities/ 875 Customer Challenge
12 USC 3410 891 Agricultural Acts 892 Economic Stabilization Act 893 Environmental Matters 894 Energy Allocation Act 895 Freedom of Information Act Exchange Corrupt Organizations

LABOR 710 Fair Labor Standards

REAL PROPERTY
210 Land Condemnation 220 Foreclosure 230 Rent Lease & Ejectment 240 Torts to Land 245 Tort Product Liability 290 All Other Real Property

CIVIL RIGHTS 441 Voting 442 Employment 443 Housing/
Accommodations 444 Welfare 440 Other Civil Rights

861 HIA (1395ff) Act 862 Black Lung (923) 720 Labor/Mgmt. Relations 863 DIWC/DIWW (405(g)) 864 SSID Title XVI PRISONER PETITIONS 730 Labor/Mgmt.Reporting 865 RSI (405(g)) 510 Motions to Vacate & Disclosure Act FEDERAL TAX SUITS Sentence 740 Railway Labor Act
Habeas Corpus: 530 General 535 Death Penalty 540 Mandamus & Other 550 Civil Rights 555 Prison Condition

790 Other Labor Litigation 791 Empl. Ret. Inc.
Security Act

870 Taxes (U.S. Plaintiff
or Defendant)

871 IRS--Third Party
26 USC 7609

Under Equal Access to Justice 950 Constitutionality of State Statutes 890 Other Statutory Actions

900Appeal of Fee Determination

V. ORIGIN
1 Original
Proceeding

(PLACE AN "X" IN ONE BOX ONLY) 2 Removed from
State Court

3

Remanded from Appellate Court

Transferred from 4 Reinstated or 5 another district (specify) Reopened

6 Multidistrict
Litigation

Appeal to District Judge from 7 Magistrate Judgment

VI. CAUSE OF ACTION VII. REQUESTED IN COMPLAINT: VIII. RELATED CASE(S) IF ANY
DATE FOR OFFICE USE ON LY RECEIPT #

(Cite the U.S. Civil Statute under which you are filing and write brief statement of cause. 29 Do not cite jurisdictional statutes unless diversity.)

USC § 1132 (a) (1) (13)

ERISA Violation
DEMAND $ CHECK YES only if demanded in complaint: JURY DEMAND: Yes No



CHECK IF THIS IS A CLASS ACTION UNDER F.R.C.P. 23 (See instructions): JUDGE

DOCKET NUMBER

SIGNATURE OF ATTORNEY OF RECORD

AMOUNT

APPLYING IFP

JUDGE

MAG. JUDGE