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Case 1:13-cv-00107-CW-BCW Document 1 Filed 08/02/13 Page 1 of 1

JS 44 (Rev. 12/I2)

CIVIL COVER SHEET

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 NEXT PAGE OF THIS FORM)

I. (a) PLAINTIFFS
KURT A. GREEN

DEFENDANTS

MERCK & CO., INC.,

(b) County of Residence of First Listed Plaintiff Weber County

County of Residence of First Listed Defendant

(EXCEPT IN U.S. PLAINTIFF CASES)

(IN {f.S. PLAINTIFF CASES ONLY)

NOTE

IN LAND CONDEMNATION CASES, USE THE LOCATION OF
THETRACTOFLANDINVOLVED

(C) Attorneys (Firm Name, Address, and Telephone Number)

David J. Holdsworth, 0452, 9125 South Monroe Plaza Way, Suite C,
Sandy, UT 84070,801-352-7701, Fax: 801-567-9960

Attorneys (If Known)

II. BASIS OF JURISDICTION (Place an "X" inOneBoxOnlyJ

III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an "X" in One Box for Plamtiff

(For Dtversity Cases Only)

and One Box for Dejimdant)

0

I U.S. Government

Plaintiff

Jill 3 Federal Question

(US. Government Not a Party)

Citizen of This State

PTF DEF
Cit I
I

0

Incorporated or Principal Place

of Business In This State

PTF
0 4

DEF
Cit 4

0 2 U.S. Government

Defendant

0 4 Diversity

(Indicate Cillzenship of Parties in Item lll)

Citizen of Another State

0 2

0

2

Incorporated and Principal Place
of Business In Another State

0 5

0 5

IV NATURE OF SUIT (Place an "X" m one Box Only)

PERSONAL INJURY

PERSONAL INJURY

.:iCtuL

0 II 0 Insurance
0 120 Marine
0 130 Miller Act
0 140 Negotiable Instrument
0

ISO Recovery of Overpayment

& Enforcement of Judgment

0 15 I Medicare Act
0 152 Recovery of Defaulted

Student Loans
(Excludes Veterans)

0 153 Recovery of Overpayment

of Veteran's Benefits

0 160 Stockholders' Suits
0 190 Other Contract
0 195 Contract Product Liability
0 196 Franchise

o.REA I PR PER'l'Y
0 210 Land Condemnation
0 220 Foreclosure
0 230 Rent Lease & Ejectment
0 240 Torts to Land
0 245 Tort Product Liability
0 290 All Other Real Property

0 310 Airplane
0 3 I 5 Airplane Product

Liability

0 320 Assault, Libel &

Slander

0 330 Federal Employers'

Liability

0 340 Marine
0 345 Marine Product

Liability

0 350 Motor Vehicle
0 355 Motor Vehicle

Product Liability

0 360 Other Personal

Injury

0 362 Personal Injury·

Medical Malpractice

.... • :CMLR:lG
0 440 Other Civil Rights
0 441 Voting
0 442 Employment
0 443 Housmg/

Accommodations

. ;· Nv::·•·•*1·•A>!I•T

0 365 Personal Injury •
Product Liability

0 367 Health Care/

Pharmaceutical
Personal Injury
Product Liability
0 368 Asbestos Personal

Injury Product
Liability

PERSONAL PROPERTY

0 370 Other Fraud
0 371 Truth in Lending
0 380 Other Personal

Property Damage
0 3 85 Property Damage
Product Liability

PRISONERI'ftl'l!lONS · .

Habeas Corpus:

0 463 Alien Detainee
0 510 Motions to Vacate

Sentence
0 530 General

0 445 Amer. w/Disabilities • 0 535 Death Penalty

Employment

Other:

0 446 Amer. w/Disabilities · 0 540 Mandamus & Other

Other

0 448 Education

0 550 Civil Rights
0 555 Prison Condition
0 560 Civil Detainee •

Citizen or Subject of a

0 3

0

3 Foreign Nation

0 6

0 6

Forei

1:',

'10ii!'O
0 625 Drug Related Seizure

of Property 21 USC 881

0 690 Other

u

0 422 Appeal 28 USC I 58
0 423 Withdrawal
28 usc 157

0 820 Copyrights
0 830 Patent
0 840 Trademark

0 861 HIA (I 395ft)
0 862 Black Lung (923)
0 863 DIWC/DIWW (405(g))
0 864 SSID Title XVI
0 865 RSI (405(g)}

FEDER.4&1'l\XSUI'l'S' I

0 870 Taxes (U.S. Plaintiff

or Defendant)

0 871 IRS-Third Party

26 usc 7609

0 710 Fair Labor Standards

Act

0 720 Labor/Management

Relations

0 7 40 Railway Labor Act
0 751 Family and Medical

Leave Act

0 790 Other Labor Litigation
1:!1 79 I Employee Retirement
Income Security Act

'lUI

0 462 Naturalization Apphcation
0 465 Other Immigration

Actions

·:·c:·

0 375 False Claims Act
0 400 State Reapportionment
0 4 I 0 Antitrust
0 430 Banks and Banking
0 450 Commerce
0 460 Deportation
0 4 70 Racketeer Influenced and

Corrupt Organizations

0 480 Consumer Credit
0 490 Cable/Sat TV
0 850 Securities/Commodities/

Exchange

0 890 Other Statutory Actions
0 891 Agricultural Acts
0 893 Environmental Matters
0 895 Freedom oflnformation

Act

0 896 Arbitration
0 899 Administrative Procedure
Act/Review or Appeal of
Agency Decision

0 950 Constitutionality of

State Statutes

V. 0 Rl GIN (Place an "X" in One Box Only)
)!!( I Original

0 2 Removed from

Proceeding

State Court

Conditions of
Confinement

0 3 Remanded from
Appellate Court

0 4 Reinstated or

Reopened

0 5 Transferred from
Another District
(.'pecifY)

0 6 Multidistrict

Litigation

VI. CAUSE OF ACTION 1-:B;::r~ie~f;_;;de:;.st..:cr~ip~ti;..;.o:.;.n,;;,o;:;;fc;..;.a;..;.us;;.;e..;.;: ;...;.;..;.;;..;;.;~....::.;=:.;..:..:.~~....:..:.::..:.. _______________ _ _________ _ _

Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):
Em lo ee Retirement Income Securit Act

VII. REQUESTED IN

COMPLAINT:

Failure to pay separation benefits under ERISA Plan
0 CHECK IF THIS IS A CLASS ACTION
DEMAND$

UNDER RULE 23, F.R.Cv.P.

CHECK YES only if demanded in complaint
JURY DEMAND:

;81 Yes

0 No

VIII. RELATED CASE(S)

IF ANY

(See instructions):

DATE
08/01/2013
FOR OFFICE USE ONLY

JUDGE

~A TURf a A JORNHOF raRD

av1

. o swc-...I..L_

DOCKET NUMBER

Digitally signed by David J. Holdsworth

· ~

RECEIPT#

AMOUNT

APPLYING IFP

Case: 1: 13-cv-001 07

JUI Assigned To : Waddoups, Clark

Assign. Date : 8/2/2013
Description: Green v. Merck & Co