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TRIAL COURT OF MASSACHUSE(TS <br /> -CAVIL ACTIO-N-COVER-SHEET _ �URM.IOR-COURX=DERARTME-NT <br /> COUNTY BARNSTABLE <br /> OF <br /> PLAINTIFF(S)Robert J. Zammito, et,al. DEFENDANT(S)alashpee Conservation Commission, et <br /> Type Plaintiffs Attorney name,Address, City/State/Zlp Type Defendant's Attorney Name,Address, City/State/Zip <br /> Phone Number and BBO# Phone Number(If Known) <br /> Brian,J. Wall, Esq. <br /> 90 Route 6A, Sandwich MA 02563 <br /> (508)888-5700 <br /> BBO#560063 <br /> TYPE OF ACTION AND TRACK DESIGNATION(See reverse side) <br /> CODE NO. TYPE OF ACTION(specify) TRACK IS THIS A JURY CASE? <br /> D99 Other Equitable Remedies (specify) - Fast Track ) Yes t; l No <br /> The following is a full,itemized and detailed statement of the facts on which plaintiff relies to determine <br /> money damages..For this form,disregard double or treble damage claims; indicate single damages only. <br /> TORT CLAIMS <br /> (Attach additional sheets as necessary) <br /> A. Documented medical expenses to date: <br /> 1. Total hospital expenses $ <br /> 2. Total doctor expenses $ <br /> 3. Total chiropractic expenses $ <br /> 4. Total physical therap expenses $ <br /> 5. Total other expenses describe) $ <br /> Subtotal $ <br /> B. Documented Iost wages and compensation to date <br /> p $ <br /> C. Documented properfy damages to date $ <br /> D.. Reasonably anticipated future medical expenses $ <br /> E. Reasonably anticipated lost wages and compensation to date $ <br /> F. Other documented items of damages (describe) <br /> G. Brief description of plaintiffs injury, $p p � ry,including nature and extent of injury (describe) <br /> Total $ <br /> CONTRACT CLAIMS <br /> (Attach additional sheets as necessary) <br /> Provide a detailed description of claim(s): <br /> TOTAL $............... <br /> PLEASE IDENTIFY,BY CASE NUMBER,NAME AND COUNTY,ANY RELATED ACTION TENDING IN THE SUPERIOR <br /> COURT DEPARTMENT <br /> "T hereby certify that I have complied with the requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution(SJC <br /> Rule 1:18)requiring that I provide my clients with inform a' n a ut court-connected dispute resolution services and discuss with them the <br /> advantages and disadvantages of the various methods." <br /> Signature of Attorney of Record Date: Aug 10,2012 <br /> A.O.S.C.3-2007 <br />