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CIVIL ACTION DOCKETNO.(S) Trial Court of Massachusetts <br /> Superior Court Department <br /> COVER SHEET p p <br /> County: BARNSR'AB F <br /> PLAINTIFF(S) DEFENDANT(S) JAMES E. REGAN II, M�HALL BREM <br /> JOSEPH WEINSTEIN AND PATRICIA WEINSPEIIV. ROBERT NELSON EDWARD GOV6NI1 ZF'LL ELIZINBIIrtR , <br /> and RICHARD GGERRERA, in thein capacit as <br /> NEY.FIRM NAME,ADDRESS AND TELEPHONE ATTORNEY (if known) Appeals <br /> ROBERT F. MILLS, ESQ. (508) 775-3665 <br /> WYNN & WYNN, P.c. <br /> board of B09Q. 4� , HYANNIS, MA 02601 <br /> Origin code and track designation <br /> Place an x in one box only: ❑ 4. F04 District Court Appeal c.231, S. 97 &104 (After <br /> 1. F01 Original Complaint trial) (X) <br /> 2. F02 Removal to Sup.Ct. C.231,s.104 ❑ 5. F05 Reactivated after rescript; relief from <br /> (Before trial) (F) judgment/Order (Mass.R.Civ.P.60) (X) <br /> ❑ 3. F03 Retransfer to Sup.Ct.C.231,s.102C (X) ❑ 6. E10 Summary Process Appeal (X) <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 40A ( ) ( )Yes (XX) 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 therapy expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ . . . . . . . . . . . . . <br /> 5. Total other expenses (describe) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ . . . . . . . . . . . . . <br /> Subtotal $ . . . . . . . . . . . . . <br /> Blecumented lost wages and compensation to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ . . . . , , . , , , , , <br /> C. cumented property damages to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . <br /> D. Reasonably anticipated future medical and hospital expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ . . . . . . . . . . . . . <br /> E. Reasonably anticipated lost wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . <br /> F. Other documented items of damages (describe) <br /> $ . . . . . . . . . . . . . <br /> G. Brief description of plaintiff's injury, including nature and extent of injury (describe) <br /> $. . . . . . . . . . . . . <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 /> `9 hereby certify that I have compiled with the requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on <br /> Dispute Resolution (SJC Rule 1:18) re ing that I provide my clients with information about court-connected dispute <br /> rn services and discuss with he the a an gas and disadvantages of the various methods:' <br /> 110re of Attorney of Record _JkDATE: 11/17/03 <br /> ROGER F. MILLS <br /> AOTC-5 mto005-11/99 <br /> A.O.S.C.1-2000 <br />