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TRIAL COURT OF MASSACHUSETTS <br /> CIVIL ACTION COVER SHEET SUPERIOR COURT DEPARTMENT DOCKET NO. <br /> COUNTY BARNSTABLE <br /> OF <br /> rLA1NTIFF(S) MARY G. RYAN DEFENDANT(S) MASHPEE ZONING BOARD OF <br /> APPEALS et al. <br /> Type Plaintiff's Attorney name,Address, City/State/Zip Type Defendant's Attorney Name, Address, City/State/Zip <br /> Phone Number and BBO# Phone Number(If Known) <br /> William A. Ryan, Jr. <br /> Dane & Howe <br /> 45 School Street <br /> Boston, MA 02108 <br /> TYPE OF ACTION AND TRACK DESIGNATION(See reverse side) <br /> CODE NO. TYPE OF ACTION(specify) TRACK IS THIS A JURY CASE? <br /> CO2 Zoning Appeal F (�' I Yes (x" I 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 lost wages and compensation to date $ <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 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 claim(s): <br /> TOTAL $............... <br /> PLEASE IDENTIFY,BY CASE NUMBER,NAME AND COUNTY,ANY RELATED ACTION PENDING IN THE SUPERIOR <br /> COURT DEPARTMENT <br /> •eby 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 information about court-connected dispute resolution services and discuss with them the <br /> advantages and disadvantages of theyayiou ethods." <br /> Signature of Attorney of Record Date: December , 2013 <br /> A.O.S.C.3-2007 <br />