EPSTEIN
page 6 / 93 . OCR, unverified
SLANDER
[ ] 330 FEDERAL
EMPLOYERS'
LIABILITY
[ ] 340 MARINE
[ ] 345 MARINE PRODUCT
LIABILITY
[ ] 350 MOTOR VEHICLE
[ ] 355 MOTOR VEHICLE
PRODUCT LIABILITY
["] 360 OTHER PERSONAL
INJURY
[ ] 362 PERSONAL INJURY -
MED MALPRACTICE
ACTIONS UNDER STATUTES
CIVIL RIGHTS
[ ] 440 OTHER CIVIL RIGHTS
(Non-Prisoner)
[ ] 441 VOTING
[ ] 442 EMPLOYMENT
[ ] 443 HOUSING/
ACCOMMODATIONS
[ ] 445 AMERICANS WITH
DISABILITIES -
EMPLOYMENT
[ ] 446 AMERICANS WITH
DISABILITIES -OTHER
[ ] 448 EDUCATION
Check if demanded in complaint:
□
CHECK IF THIS IS A CLASS ACTION
UNDER F.R.C.P. 23
NATURE OF SUIT
PERSONAL INJURY
FORFEITURE/PENAL TY
[ ]367 HEALTHCARE/
PHARMACEUTICAL PERSONAL [ ] 625 DRUG RELATED
INJURY/PRODUCT LIABILITY
SEIZURE OF PROPERTY
[ ] 365 PERSONAL INJURY
USC 881
PRODUCT LIABILITY
[ ] 368 ASBESTOS PERSONAL [ l 590 OTHER
INJURY PRODUCT
LIABILITY
PROPERTY RIGHTS
[ ] 820 COPYRIGHTS
[ ] 830 PATENT
ACTIONS UNDER STATUTES
BANKRUPTCY
[ ] 422 APPEAL
use 158
[ ] 423 WITHDRAWAL
USC 157
PERSONAL PROPERTY
[ ] 370 OTHER FRAUD
[ ] 371 TRUTH IN LENDING
[ ] 835 PATENT-ABBREVIATED NEW DRUG APPLICATION
[ ] 840 TRADEMARK
[ ] 380 OTHER PERSONAL
PROPERTY DAMAGE
[ ] 385 PROPERTY DAMAGE
PRODUCT LIABILITY
PRISONER PETITIONS
[ ] 463 ALIEN DETAINEE
[ ] 510 MOTIONS TO
VACATE SENTENCE
USC 2255
[ ] 530 HABEAS CORPUS
[ ] 535 DEA TH PENAL TY
[ ] 540 MANDAMUS & OTHER
PRISONER CIVIL RIGHTS
[ ] 550 CIVIL RIGHTS
[ ] 555 PRISON CONDITION
[ ] 560 CIVIL DETAINEE
LABOR
[ ]710 FAIR LABOR
STANDARDS ACT
[ ] 720 LABOR/MGMT
RELATIONS
[ ] 740 RAILWAY LABOR ACT
[ ] 751 FAMILY MEDICAL
LEAVE ACT (FMLA)
[ ] 790 OTHER LABOR
LITIGATION
[ ] 791 EMPL RET INC
SOCIAL SECURITY
I ] 861 HIA (139511)
[ ] 862 BLACK LUNG (923)
[ ] 863 DIWC/DIWW (405(g))
[ ] 864 SSID TITLE XVI
[ ] 865 RSI (405(g))
FEDERAL TAX SUITS
[ ] 870 TAXES (U.S. Plaintiff or
Defendant)
[ ] 871 IRS-THIRD PARTY
use 7609
SECURITY ACT (ERISA)
IMMIGRATION
[ ] 462 NATURALIZATION
APPLICATION
[ ] 465 OTHER IMMIGRATION
ACTIONS
CONDITIONS OF CONFINEMENT
OTHER STATUTES
[ ] 375 FALSE CLAIMS
[ ] 376 QUI TAM
[ ]400STATE
REAPPORTIONMENT
[ ]410ANTITRUST
[ ] 430 BANKS & BANKING
[ ] 450 COMMERCE
[ ] 460 DEPORTATION
[ ] 470 RACKETEER INFLU-
ENCED & CORRUPT
ORGANIZATION ACT
(RICO)
[ ] 480 CONSUMER CREDIT
[ ] 490 CABLE/SATELLITE TV
[ ] 850 SECURITIES/
COMMODITIES/
EXCHANGE
[ ] 890 OTHER STATUTORY
ACTIONS
[ ] 891 AGRICULTURAL ACTS
[ ] 893 ENVIRONMENTAL
MATTERS
[ ] 895 FREEDOM OF
INFORMATION ACT
[ ] 896 ARBITRATION
[ ] 899 ADMINISTRATIVE
PROCEDURE ACT/REVIEW OR
APPEAL OF AGENCY DECISION
[ ] 950 CONSTITUTIONALITY OF
STATE STATUTES
DO YOU CLAIM THIS CASE IS RELATED TO A CIVIL CASE NOW PENDING IN S.D.N.Y.
AS DEFINED BY LOCAL RULE FOR DIVISION OF BUSINESS 13?
IF SO, STATE:
DEMAND $ _____ OTHER _____ JUDGE ___________ DOCKET NUMBER. _____
_
Check YES only if demanded in complaint
JURY DEMAND: 00 YES DJo
NOTE: You must also submit at the time of filing the Statement of Relatedness form (Form IH-32).
Case 1:19-cv-10788-GHW-DCF Document 2 Filed 11/21/19 Page 2 of 2
(PLACE AN x IN ONE BOX ONLY)
ORIGIN
1 Original
Proceeding
D 2 Removed from
D 3 Remanded
State Court
from
Appellate
D 4 Reinstated or
Reopened
D 5 Transferred from D 6 Multidistrict
(Specify District)
Litigation
(Transferred)
D 7 Appeal to District
Judge from
Magistrate Judge
D a. all parties represented
Court
D 8 Multidistrict Litigation (Direct File)
D b. At least one party
is prose.
(PLACE AN x IN ONE BOX ONLY)
BASIS OF JURISDICTION
1 U.S. PLAINTIFF
O 2 U.S. DEFENDANT O 3 FEDERAL QUESTION
004 DIVERSITY
IF DIVERSITY, IND/CA TE
CITIZENSHIP BELOW.
(U.S. NOT A PARTY)
CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY)
(Place an [X] in one box for Plaintiff and one box for Defendant)
PTF
DEF
PTF DEF
PTF
DEF
CITIZEN OF THIS STATE
[ ] 1
[ ] 1
CITIZEN OR SUBJECT OF A
[ ] 3 [ ] 3
INCORPORATED and PRINCIPAL PLACE
[ ] 5
[ ] 5
FOREIGN COUNTRY
OF BUSINESS IN ANOTHER STATE
CITIZEN OF ANOTHER STATE
[)Cj 2
[)Cj 2
INCORPORATED or PRINCIPAL PLACE
[ ] 4 [ ] 4
FOREIGN NATION
[ ] 6
[ ] 6
OF BUSINESS IN THIS STATE
PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES)
Plaintiff is a resident of Arizona c/o Cuti Hecker Wang LLP, 305 Broadway, Suite 607, New York, NY
10007.
DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES)
Defendants lndyke and Kahn are residents of the U.S. Virgin Islands.
DEFENDANT(S) ADDRESS UNKNOWN
REPRESENTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DILIGENCE, TO ASCERTAIN
THE RESIDENCE ADDRESSES OF THE FOLLOWING DEFENDANTS:
Darren K. lndyke and Richard D. Kahn are sued as executors of the Estate of Jeffrey E. Epstein.
Per 28 USC 1332, Defendants are deemed citizens of the U.S. Virgin Islands, the domicile of decedent
Epstein. Defendants' residential addresses are unknown to Plaintiff. Defendants' counsel is listed above.
COURTHOUSE ASSIGNMENT
I hereby certify that this case should be assigned to the courthouse indicated below pursuant to Local Rule for Division of Business 18, 20 or 21.