'id"
by local rules of court. This form, Conference of the United States inSeptember 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
SUE WILLIAMSON VALERI
(b) County of Residence of First Listed Plainti
(EXCEPT IN u.s. PLAINT
(C) AttQrneys (l-lrm Name, Address, and TeleellOne N.umber)
Davrd L. Braverman, Esq. & Richard Julie Esq.
Braverman Kaskey, PC., 1650 Market Street, 56th Floor, Philadelphia,
PA 19103 215 575-380
o I
o 2
DEFENDANTS
MYSTIC INDUSTRIES CORPORATION
County of Residence ofFirst Listed Defendant
NOTE:
(IN U.S. PLAINTIFF CASES ONLY)
IN LAND CONDElvlNATlON CASES, USE THE LOCATION OF
THE TRACT OF LAND INVOLVED.
Attorneys (I[Known)
II. BASIS OF JURISDI TI (placean "X" in One Box Only)
u.s. Government
Plaintiff
U.S. Government
Defendant
ederal Question
(U.S. Government Not a Parly)
Diversity
(Indicate Citizenship o[Parties in Item lII)
Citizen ofThis State
Citizen ofAoother Stat
DEF
o I Incorporated or Principal Place
of Business In This State
Incorporated and Principal Place
ofBusiness In Another State
Foreign Nation
a 5 0 5
a 6 0 6
IV NATURE OF SUIT (place an ''){'' in One Box Only)
o 110 Insurance PERSONAL INJURY PERSONAL INJURY a 625 Drug Related Seizure 0 422 Appeal 28 USC 158 0 375 False Claims Act
a 120 Marine 0310 Airplane a 365 Personal Injury ofPropetty 21 USC 881 0 423 Withdrawal 0 400 State Reapportionment
o 130 Miller Act o 315 Airplane Product Product Liability o 6900tner 28 USC 157 o 410 Antitrust
a 140 Negotiable Instrument Liability 0 367 Health Carel 0 430 Banks and Banking
o 150 Recovery ofOverpayment 0320 Assault. Libel & Pharmaceutical , !fS- 0 450 Commerce
& Enforcement ofJudgment Slander Personal Injury f 1!;J 820 Copyrights 0 460 Deportation
o 151 Medicare Act 0330 Federal Employers' Product Liability Patent 0 470 Racketeerlufluenced and
o 152 Recovery ofDefilulted Liability 0 368 Asbestos Personal OJ 840 Trademark Corrupt Organizations
Student Loans 0 340 Marine Injury Product iiii!!&id!iii!iiDiliiiiiilW[lfii]1j1 0 480 Consumer Credit
(Exc!. Veterans) 0 345 Marine Product Liability 12' ,1 I 0 490 Cable/Sat TV
o 153 Recovery ofOverpayment Liability PERSONAL PROPERTY 0 710 Fair Labor Standards 0 861 HlA (l395ft) 0 850 Securities!Commodities!
of Veteran's Benefits a 350 Motor Vehicle 0 370 Other Fraud Act 0 862 Black Lung (923) Exchange
o 160 Stockholders' Suits a 355 Motor Vehicle 0 371 Truth in Lending 0 720 LaborlMgmt. Relations 0 863 DIWCiDlWW (405(g)) 0 890 Other Statutory Actions
o 190 Otner Contract Product Liability a 380 Other Personal a 740 Railway Labor Act 0 864 SSID Title XVI 0 891 Agricultural Acts
o 195 Contract Product Liability 0 360 Other Personal Property Damage a 751 Family and Medical 0 865 RSI (405(g)) 0 893 Environmental Matters
o 196 Franchise Injury 0 385 Property Damage Leave Act 0 895 Freedom oflnformation
o 362 Personal Injury Product Liability 0 790 OdIeI' Labor Litigation Act
o 896 Arbitration
791 0 &99 Administrative Procedure .. Ii.
O
o 210 Land Condemnation a 440 Other Civil Rights a 510 Motions to Vacate
o 220 Foreclosure o 441 Voting Sentence
o 230 Rent Lease & Ejectment a 442 Employment Habeas Corpus:
o 240 Torts to Land o 443 Housingl 0 530 General
o 245 Tort Product Liability Accommodations 0 535 Death Penalty .#'JJ'''
o 290 All Odler Real Property o 445 Arner. wiDisabilities a 540 Mandamus & Other o 462 Naturalization Application
Employment 0 550 Civil Rights o 463 Habeas Corpus.
o 446 Amer. wiDisabilities 0 555 Prison Condition Alien Detainee
Other 0 560 Civil Detainee (Prisoner Petition)
r'\
o 448 Education Conditions of o 465 Other Immigration
Confinement Actions
o 870 Taxes (U.S. Plaintiff ActIReview or Appeal of
or Defendant) Agency Decision
o 871 IRS-Third Party 0 950 Constitutionality of
26 USC 7609 State Statutes
V. {l}RI]GIN (place an "X" in One Box Only)
O
Transferred from
I 0 2 Removed from 0 3 Remanded from 0 4 Reinstated or 5 another dIstrict 0 6 Multidistrict
I'roceedmg State Court Appellate Court Reopened fsnedjfi,i Litigation
Cite the U.S. Statute under which you are filing (Do not clteju,lsdlctJonal statutes unless diversity):