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TRIAL COURT OF MASSACHUSETTS �J <br /> SUPERIOR COURT DEPARTMENT DOCKET N0, J !— <br /> CIVIL ACTION COVER SHEET ___...._ _ _ <br /> COUNTY JBARNSTABLE <br /> OF Jonathan D. Furbush, William A. <br /> Jeanne S-. Mantel Blaisdell, Ronald S. Bonvie, James <br /> PLAINTIFF and Lewis Mantel <br /> S) DEFENDANT(S)Reiffarth, Judith M. Horton, John M. <br /> Dorsey and Domingo K. DeBarrows <br /> Type Plaintiff's 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 /> Patrick J. Costello <br /> Merrick, Louison &Costello LLP <br /> David Nunheimer, 540 Main St., Hyannis, MA 02601 g7 Batterymarch Street <br /> Bosoton, MA 02110 <br /> TYPE OF ACTION AND TRACK DESIGNA"TION (See reverse side) <br /> CODE NO. TYPE OF ACTION (specify) TRACK IS THIS A JURY CASE? <br /> Yes No <br /> CO2 Zoning Appeal C L e 40A - 7ast 'Crack <br /> The following is a full, itemized ar: . detailed statement of the facts on which plaintiff relies to determine <br /> money damages. For this form, L.' ,regard 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 /> I. Total hospital expenses $ <br /> 2. Total doctor expenses $ __ <br /> 3. Total chiropractic expenses $ <br /> 4. Total physical therap expenses $ <br /> S. Total other expenses describe) <br /> Subtotal $_ <br /> B. Documented lost wages and compensation to (late $ <br /> C. Documented property 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 plaintiff's injury, including nature and extent of injury (describe) <br /> Total $ <br /> — — CONTRACT CLAIMS <br /> (Attach additional sheets as necessary) <br /> Provide a detailed description of e ,::Im(s): <br /> TOTAL $............... <br /> PLEASE IDENTIFY, BY CASE NUMBER,NAME AND COUNTY,Ai rY RELATED ACTION PENDING IN THE SUPERIOR <br /> COURT DEPARTMENT �....._-._. _._-.____.- _.._ ._-_. - _ -------------- <br /> ___ -_ ----- <br /> ._...--- <br /> . ----.__.. -.-- --------- <br /> --- <br /> _------- <br /> _-------------- <br /> ._ <br /> Hereby certify that I have complied with the requirements of Rule 5 of tile r <br /> e Supreme Judicial Cout Uniform Rules on Dispul< Resolution(SJC <br /> Ile 1:18)requiring that I provide my clients with intbrmation about court-connected dispute resolution services and discuss with them the <br /> ivantages and disadvantages of the various methods." <br /> of Record Date: Sep 9,2013 <br /> Signature of Attorney _ <br /> A.O.S.C.3-2007 <br />