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SHORT TITLE: CASE NUMBER

CIVIL CASE COVER SHEET ADDENDUM AND STATEMENT OF LOCATION (CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO COURTHOUSE LOCATION)
This form is required pursuant to LASC Local Rule 2.0 in all new civil case filings in the Los Angeles Superior Court. Item I. Check the types of hearing and fill in the estimated length of hearing expected for this case:
JURY TRIAL? YES CLASS ACTION? YES LIMITED CASE? YES TIME ESTIMATED FOR TRIAL ____ HOURS/ DAYS Item II. Select the correct district and courthouse location (4 steps ­ If you checked "Limited Case", skip to Item III, Pg. 4): Step 1: After first completing the Civil Case Cover Sheet Form, find the main civil case cover sheet heading for your case in the left margin below, and, to the right in Column A, the Civil Case Cover Sheet case type you selected. Step 2: Check one Superior Court type of action in Column B below which best describes the nature of this case. Step 3: In Column C, circle the reason for the court location choice that applies to the type of action you have checked. For any exception to the court location, see Los Angeles Superior Court Local Rule 2.0.

Applicable Reasons for Choosing Courthouse Location (see Column C below)
1. 2. 3. 4. 5. Class Actions must be filed in the County Courthouse, Central District. May be filed in Central (Other county, or no Bodily Injury/Property Damage). Location where cause of action arose. Location where bodily injury, death or damage occurred. Location where performance required or defendant resides. 6. Location of property or permanently garaged vehicle. 7. Location where petitioner resides. 8. Location wherein defendant/respondent functions wholly. 9. Location where one or more of the parties reside. 10. Location of Labor Commissioner Office.

Step 4: Fill in the information requested on page 4 in Item III; complete Item IV. Sign the declaration. A
Auto Tort
Civil Case Cover Sheet Category No. Auto (22) Uninsured Motorist (46) Type of Action (Check only one) A7100 Motor Vehicle - Personal Injury/Property Damage/Wrongful Death A7110 Personal Injury/Property Damage/Wrongful Death ­ Uninsured Motorist A6070 Asbestos Property Damage

B

C
Applicable Reasons See Step 3 Above 1., 2., 4. 1., 2., 4. 2. 2. 1., 2., 3., 4., 8. 1., 2., 4. 1., 2., 4. 1., 2., 4. 1., 2., 4. 1., 2., 3. 1., 2., 4. 1., 2., 3. 1., 2., 3. 1., 2., 3. 1., 2., 3.

Other Personal Injury/Property Damage/Wrongful Death Tort

Asbestos (04) Product Liability (24)

A7221 Asbestos - Personal Injury/Wrongful Death A7260 Product Liability (not asbestos or toxic/environmental) A7210 Medical Malpractice - Physicians & Surgeons A7240 Other Professional Health Care Malpractice A7250 Premises Liability (e.g., slip and fall)

Medical Malpractice (45)

Other Personal Injury Property Damage Wrongful Death (23)

A7230 Intentional Bodily Injury/Property Damage/Wrongful Death (e.g., assault, vandalism, etc.) A7270 Intentional Infliction of Emotional Distress A7220 Other Personal Injury/Property Damage/Wrongful Death

Non-Personal Injury/Property Damage/Wrongful Death Tort

Business Tort (07) Civil Rights (08) Defamation (13) Fraud (16)

A6029 A6005

Other Commercial/Business Tort (not fraud/breach of contract) Civil Rights/Discrimination

A6010 Defamation (slander/libel) A6013 Fraud (no contract)

LACIV 109 (Rev. 01/07) LASC Approved 03-04

CIVIL CASE COVER SHEET ADDENDUM AND STATEMENT OF LOCATION

LASC, rule 2.0 Page 1 of 4

Non-Personal Injury/Property Damage/ Wrongful Death Tort (Cont'd.)

SHORT TITLE:

CASE NUMBER

A
Civil Case Cover Sheet Category No.

B
Type of Action (Check only one) A6017 Legal Malpractice A6050 Other Professional Malpractice (not medical or legal) A6025 Other Non-Personal Injury/Property Damage tort

C
Applicable Reasons -See Step 3 Above 1., 2., 3. 1., 2., 3. 2.,3.

Professional Negligence (25) Other (35)

Employment

Wrongful Termination (36) Other Employment (15)

A6037 Wrongful Termination A6024 Other Employment Complaint Case A6109 Labor Commissioner Appeals

1., 2., 3. 1., 2., 3. 10. 2., 5. 2., 5. 1., 2., 5. 1., 2., 5. 2., 5., 6. 2., 5. 1., 2., 5., 8. 1., 2., 3., 5. 1., 2., 3., 5. 1., 2., 3., 8. 2.

Breach of Contract/ Warranty (06) (not insurance)

A6004 Breach of Rental/Lease Contract (not Unlawful Detainer or wrongful eviction) A6008 A6019 A6028 A6002 A6012 Contract/Warranty Breach -Seller Plaintiff (no fraud/negligence) Negligent Breach of Contract/Warranty (no fraud) Other Breach of Contract/Warranty (not fraud or negligence) Collections Case-Seller Plaintiff Other Promissory Note/Collections Case

Contract

Collections (09) Insurance Coverage (18) Other Contract (37)

A6015 Insurance Coverage (not complex) A6009 Contractual Fraud A6031 Tortious Interference A6027 Other Contract Dispute(not breach/insurance/fraud/negligence)

Real Property

Eminent Domain/Inverse Condemnation (14) Wrongful Eviction (33) Other Real Property (26)

A7300 Eminent Domain/Condemnation

Number of parcels______

A6023

Wrongful Eviction Case

2., 6. 2., 6. 2., 6. 2., 6. 2., 6. 2., 6. 2., 6. 2., 6. 2., 5.

A6018 Mortgage Foreclosure A6032 Quiet Title A6060 Other Real Property (not eminent domain, landlord/tenant, foreclosure)

Judicial Review Unlawful Detainer

Unlawful DetainerCommercial (31) Unlawful DetainerResidential (32) Unlawful DetainerDrugs (38) Asset Forfeiture (05) Petition re Arbitration (11)

A6021 Unlawful Detainer-Commercial (not drugs or wrongful eviction) A6020 Unlawful Detainer-Residential (not drugs or wrongful eviction) A6022 Unlawful Detainer-Drugs A6108 Asset Forfeiture Case

A6115 Petition to Compel/Confirm/Vacate Arbitration

LACIV 109 (Rev. 01/07) LASC Approved 03-04

CIVIL CASE COVER SHEET ADDENDUM AND STATEMENT OF LOCATION

LASC, rule 2.0 Page 2 of 4

SHORT TITLE:

CASE NUMBER

Judicial Review (Cont'd.)

A
Civil Case Cover Sheet Category No.

B
Type of Action (Check only one) A6151 Writ - Administrative Mandamus

C
Applicable Reasons See Step 3 Above 2., 8. 2. 2. 2., 8.

Writ of Mandate (02) Other Judicial Review (39) Antitrust/Trade Regulation (03)

A6152 A6153 A6150

Writ - Mandamus on Limited Court Case Matter Writ - Other Limited Court Case Review Other Writ /Judicial Review

A6003

Antitrust/Trade Regulation

1., 2., 8. 1., 2., 3. 1., 2., 8. 1., 2., 8. 1., 2., 3., 8. 1., 2., 5., 8.

Provisionally Complex Litigation

Construction Defect (10) Claims Involving Mass Tort (40) Securities Litigation (28) Toxic Tort Environmental (30) Insurance Coverage Claims from Complex Case (41)

A6007 Construction defect A6006 Claims Involving Mass Tort

A6035 Securities Litigation Case

A6036 Toxic Tort/Environmental A6014 Insurance Coverage/Subrogation (complex case only)

A6141 Sister State Judgment

2., 9. 2., 6. 2., 9. 2., 8. 2., 8. 2., 8., 9. 1., 2., 8. 1., 2., 8. 2., 8. 1., 2., 8. 1., 2., 8. 2., 8. 2., 3., 9. 2., 3., 9. 2., 3., 9. 2. 2., 7. 2., 3., 4., 8. 2., 9.

Enforcement of Judgment

Enforcement of Judgment (20)

A6160 Abstract of Judgment A6107 Confession of Judgment (non-domestic relations) A6140 Administrative Agency Award (not unpaid taxes) A6114 Petition/Certificate for Entry of Judgment on Unpaid Tax A6112 Other Enforcement of Judgment Case A6033 Racketeering (RICO) Case A6030 Declaratory Relief Only

Miscellaneous Civil Complaints

RICO (27)

Other Complaints (Not Specified Above) (42) Partnership Corporation Governance(21)

A6040 Injunctive Relief Only (not domestic/harassment) A6011 Other Commercial Complaint Case (non-tort/non-complex) A6000 Other Civil Complaint (non-tort/non-complex) A6113 Partnership and Corporate Governance Case A6121 Civil Harassment A6123 Workplace Harassment A6124 Elder/Dependent Adult Abuse Case

Miscellaneous Civil Petitions

Other Petitions (Not Specified Above) (43)

A6190 Election Contest A6110 Petition for Change of Name A6170 Petition for Relief from Late Claim Law A6100 Other Civil Petition

LACIV 109 (Rev. 01/07) LASC Approved 03-04

CIVIL CASE COVER SHEET ADDENDUM AND STATEMENT OF LOCATION

LASC, rule 2.0 Page 3 of 4

SHORT TITLE:

CASE NUMBER

Item III. Statement of Location: Enter the address of the accident, party's residence or place of business, performance, or other circumstance indicated in Item II., Step 3 on Page 1, as the proper reason for filing in the court location you selected.
REASON: CHECK THE NUMBER UNDER COLUMN C WHICH APPLIES IN THIS CASE
ADDRESS:

1.
CITY:

2.

3.

4.

5.

6.

7.
STATE:

8.

9.

10.

ZIP CODE:

Item IV. Declaration of Assignment: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that the above-entitled matter is properly filed for assignment to the ___________________courthouse in the ____________________ District of the Los Angeles Superior Court (Code Civ. Proc., § 392 et seq., and LASC Local Rule 2.0, subds. (b), (c) and (d)).

Dated: ___________________

_________________________________
(SIGNATURE OF ATTORNEY/FILING PARTY)

PLEASE HAVE THE FOLLOWING ITEMS COMPLETED AND READY TO BE FILED IN ORDER TO PROPERLY COMMENCE YOUR NEW COURT CASE: 1. Original Complaint or Petition. 2. If filing a Complaint, a completed Summons form for issuance by the Clerk. 3. Civil Case Cover Sheet form CM-010. 4. Complete Addendum to Civil Case Cover Sheet form LACIV 109 (Rev. 01/07), LASC Approved 03-04. 5. Payment in full of the filing fee, unless fees have been waived. 6. Signed order appointing the Guardian ad Litem, JC form FL-935, if the plaintiff or petitioner is a minor under 18 years of age, or if required by Court. 7. Additional copies of documents to be conformed by the Clerk. Copies of the cover sheet and this addendum must be served along with the summons and complaint, or other initiating pleading in the case.

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LACIV 109 (Rev. 01/07) LASC Approved 03-04

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LASC, rule 2.0 Page 4 of 4

CIVIL CASE COVER SHEET ADDENDUM AND STATEMENT OF LOCATION