Case 1:04-cv-01225-MSK-BNB
Document 200-5
Filed 10/18/2005
Page 1 of 2
Malik M. Hasan, M.D., et al. v. Goldman Sachs 1998 Exchange Place Fund, LP, et al.
EXHIBIT D T EN ME D F N A T ' TO F RP E L SO A D H A D E E D N S MO I N O R C U I N N OTHER RELIEF CIVIL COVER SHEET
EXHIBIT D 04-cv-1225-MSK-BNB
Case 1:04-cv-01225-MSK-BNB
(PLACE AN x IN ON,E BOX ONLY)
Document 200-5
ORIGIN
Filed 10/18/2005
Page 2 of 2
LI1 1 Orignal
Proceeding
[
~2Removed from
State Couri
El 3
Remanded from Appellate Court
171 4
Reinstated or Reopened
El 5
Transferred from El
(Specify District)
6
Multidistrict
Litigation
El 7 Appeal to District
Judge from Magisirate Judge Judgment
(PLACE AN x IN ONE BOX ONLY)
BASIS OF JURISDICTION
IF DIVERSITY, INDICATE CITIZENSHIP BELOW. (28 USC 1322, 1441)
LI
1 U S PLAINTIFF
LI 2 U S DEFENDANT
LI 3 FEDERAL OUESTICN
(U S NOT A PARTY)
M4 DIVERSITY
CITIZENSHIP OF PRINCIPAL PARTIES (FOR DIVERSITY CASES ONLY)
(Place an [X] in one box for Plaintiff and one box for Defendant)
CITIZEN OF THIS STATE
PTF I J 1 12
DEF I Ji
CITIZEN OR SLIBJECT OF A
FOREIGN COUNTRY INCORPORATED or PRINCIPAL PLACE OF BUSINESS IN THIS STATE
PTF DEF 1 3 I 13
XI 4 I J4
INCORPORATED and PRINCIPAL PLACE OF BUSINESS IN AN-OTHER STATE FOREIGN NATION
PTF DEF I 15 >45
CITIZEN OF ANOTHER STATE
I *2
I 6 I
6
PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES) (Calendar Rule 4(A))
AEQ, LLC 477 Madison Avenue
8 TH
Floor
New York, New York 10022
DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES) (Calendar Rule 4(A))
MONUMENT SYSTEMS INC 5151 East Broadway Boulevard, Suite 1050 Tucson, Arizona 85711 MALIK HASSAN 8821 Greenshore Lane Las Vegas, NV 89134 (Clark County)
DEFENDANT(S) ADDRESS UNKNOWN IIECT SETI H REPRESENTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DIGECTASRANTH RESIDENCE ADDRESSES OF THE FOLLOVING DEFENDANTS
NOT APPLICABLE
Check one
THIS ACTION SHOULD BE ASSIGNED TO
(DO NOT check either box if this a PRISONER PETITION )
SIGNATrDEOF
LI
WHITE PLAINS
[IJ FOLEY SQUARE
DATE
6/,7~Y/99
ADMITTED TO PRACTICE IN THIS DISTRICT [INO [I> YES (DATE ADMITTED 2 Yr 7 3JAttorney Bar Coo,-e #
RECEIPT #
f
RS
6
Magistrate Judge is to be designated by the Clerk of the Court Magistrate Judge
James M Parkison, Clerk of Court by_______
Deputy Clerk, DATED
___________
is so Designated
UNITED STATES DISTRICT COURT (NEW YORK SOUTHERN)