### PLAINTIFFS Jane Doe The JS.44 civil cover sheet and the information contained herein neither replace nor Supplement the filing and service of pleadings a other papers as required by law. except as provided by local rules of court. This farm. approved by the Judicial Conference of the United States in September 1974. is recpared for use of the Clerk of Court for the purpose of initiating the civil docket sheet. ATTORNEYS (FIRM NAME. ADDRESS. AND TELEPHONE NUMBER Roberta A. Kaplan Kaplan Hecker & Fink LLP 350 Fifth Avenue, Suite 7110, New York, NY 10118 DEFENDANTS Darren K. Indyke and Richard D. Kahn. as executors for Estate of Jeffrey E. Epstein ATTORNEYS (IF KNOWN) Erika A. Keflerhals and William Blum, Kelerhals Palms Professional Building. 9053 Estate St. U.S. Virgin Islands 00802 Kroblin PLLC. . Suite 101 CAUSE OF ACTION (CITE THE U.S. CIVIL STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE) (DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY) 28 USC 1332; New York causes of action Has this action, case, or proceeding, or one essentially the same been previously filed in SONY at any time? No \['Yes': Judge Previously Assigned If yes, was this case Vol. 0 Invol. ❑ Dismissed. No 0 Yes 0 If yes, give date & Case No. IS THIS AN INTERNATIONAL ARBITRATION CASH No 13 Yes 0 # (PLACE AN lx) IN ONE BOX ONLY) NATURE OF SUIT # TORTS ACTIONS UNDER STATUTES ## CONTRACT PERSONAL INJURY PERSONAL INJURY FORFEITURE/PEP/ALT/ BANKRUPTCY OTHER STATUTES 367 HEALTHCARE/ PHARMACEUTICAL PERSONAL INJURY/PRCOUCT LIABILITY I 1825 DRUG RELATED ( )422 APPEAL SEIZURE OF PROPERTY 28 USC 158 ( ) 130 ACT LIABILITY I 1365 PERSONAL INJURY 21 USC 681 ( ) 423 WITHDRAWAL ( 1400 STATE PRODUCT LIABILITY f I I50 RECOVERY OF ( 1330 FEDERAL INJURY PRODUCT ( 1430 BANKS & BANKING OVERPAYMENTS EMPLOYERS LIABILITY PROPERTY RIGHTS ( 1450 COMMETICE ENFORCEMENT LIABILITY ( 1460 DEPORTATION OF JUDGMENT ( 1340 MARINE PERSONAL PROPERTY ( 1820 COPYRIGHTS ( 1470 RACKETEER INFLU. OVERPAYMENT INJURY I I 360 OTHER PERSONAL LABOR ( 1861 HIA (13ese!) 1 1850 SECURITIES/ OF VETERANS 11352 PERSONAL INJURY • PROPERTY DAMAGE ( 1862 BLACK LUNG (923) COMMODITIES/ BENEFITS MED MALPRACTICE 1 1385 PROPERTY DAMAGE I 710 FAIR LABOR ( 1863 DIWC/08VW (405(g)) EXCHANGE 11 180 STOCKHOLDERS PRODUCT LIABILITY STANDARDS ACT ( 1864 SSID TITLE XVI SUITS 1720 LABORMGMT ( 1865 R51 (406(9)) CONTRACT I I 453 AUER DETAINEE ) 740 RAILWAY LABOR ACT ACTIONS I 1510 MOTIONS TO VACATE SENTENCE I I 751 FAMILY MEDICAL FEDERAL LEAVE ACT (FIALA) LIABILITY 28 USC 2255 1870 TAXES (U.S. PISANI a ( ) 196 FRANCHISE CIVIL RIGHTS I 1530 HABEAS CORPUS 1790 OTHER LABOR Defendant) ( 1893 ENVIRONMENTAL 11535 DEATH PENALTY LITIGATION ( )871 IRSTHIRD PARTY MATTERS )440 OTHER GIRL RIGHTS I 1540 LIANDAMUS 8 OTHER 1 791 EMPL RET INC 26 USC 7609 ( 11996 FREEDOM OF (N441-PresoneN SECURITY ACT (ERISA) INFORMATION ACT REAL PROPERTY 8916 ARBITRATION PRISONER CML RIGHTS 1 1550 CIVIL RIGHTS IMMIGRATION I I 462 NATURALIZATION APPLICATION ( 1555 PRISON CONDITION 1 465 OTHER IMIAGRATION 1 1560 CML DETAINEE CONDITIONS OF CONFINEMENT ( 110 ( 1 120 INSURANCE ( 1 310 A/RPLANE ( 1315 AIRPLANE PRODUCT ( 1 140 NEGOTIABLE INSTRUMENT ( 1320 ASSAULT. UBEL SLANDER ( 1 152 RECOVERY OF DEFAULTED LIABILITY ( 1350 MOTOR VEHICLE ( 1 153 (EXCL VETERANS) RECOVERY OF PRODUCT LIABILITY is 360 OTHER PERSONAL 11195 CONTRACT PRODUCT ACTIONS UNDER STATUTES ( 210 ( )220 LAND CONDEMNATION FORECLOSURE ( 1441 VOTING 442 EMPLOYMENT 11 443 HOUSWG/ ACCOMMODATIONS ( 1230 ( 1240 RENT LEASES EJECTMENT TORTS TO LAND ( 1 445 AMERICANS WITH DISABILITIES. EMPLOYMENT ( )245 TORT PRODUCT ( 1446 AMERICANS WITH LIABILITY DISABILITIES OTHER ( )290 ALL OTHER 1448 EDUCATION REAL PROPERTY 375 FALSE CLAIMS 1376 OUI TAM 1368 ASBESTOS PERSONAL 1690 OTHER ZS USC 157 REAPPORTIONMENT ( 1410 ANTITRUST 1151 MEDICARE ACT ( 1345 MARINE PRODUCT ( 1830 PATENT ENCED S CORRuPT 370 OTHER FRAUD 1 371 TRUTH IN LENDING 1 1835 PATENT-ABBREVIATED NEW DRUGAPPLICATION ORGANIZATION ACT (RICO) STUDENT LOANS f 1355 MOTOR VEHICLE 1 840 TRADEMARK ( 1480 CONSUMER CDIT SOCIAL SECURITY ( 1490 CABLE/SATELLREITE TV ( 190 OTHER PRISONER PETITIONS RELATIONS ( 1890 OTHER STATUTORY TAX SUITS ( 1891 AGRICULTURAL ACTS ( 1899 ADMINISTRATIVE PROCEDURE ACTT REVIEW OR APPEAL OF AGENCY DECISION 11950 CONSTITUTIONALITY OF STATE STATUTES Check if demanded in complaint: ❑ CHECK IF THIS IS ACLASS ACTION UNDER F.R.C.P. 23 DEMAND \$ OTHER JUDGE DOCKET NUMBER DO YOU CLAIM THIS CASE IS RELATED TO A CIVIL CASE NOW PENDING IN S.D.N.Y. AS DEFINED BY LOCAL RULE FOR DIVISION OF BUSINESS 137 IF SO, STATE: | 1 Original Proceeding | 2 Removed from State Court | 3 Remanded from Appellate Court | 4 Reinstated or Reopened | 5 Transferred from (Specify District) | 6 Multidistrict Litigation (Transferred) | 7 Appeal to District Judge from Magistrate Judge | | --------------------------------------------------------- | --------------------------------------------------- | -------------------------------------------------------- | ------------------------------------------------- | ----------------------------------------------------------------- | ----------------------------------------------------------------- | ------------------------------------------------------------------------- | | a. all parties represented | | | | 8 Multidistrict Litigation (Direct File) | | | | b. At least one party is pro se. | | | | | | | (PLACE AN x IN ONE BOX ONLY) **BASIS OF JURISDICTION** 1 U.S. PLAINTIFF 2 U.S. DEFENDANT 3 FEDERAL QUESTION 4 DIVERSITY\ (U.S. NOT A PARTY) **IF DIVERSITY, INDICATE CITIZENSHIP BELOW.** **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
[X] 1 | DEF
[ ] 1 | CITIZEN OR SUBJECT OF A FOREIGN COUNTRY | PTF DEF
[ ] 3 [ ] 3 | INCORPORATED and PRINCIPAL PLACE OF BUSINESS IN ANOTHER STATE | PTF DEF
[ ] 5 [ ] 5 | | ------------------------ | ------------ | ------------ | --------------------------------------------------------- | ---------------------- | ------------------------------------------------------------- | ---------------------- | | CITIZEN OF ANOTHER STATE | [ ] 2 [X] 2 | | INCORPORATED or PRINCIPAL PLACE OF BUSINESS IN THIS STATE | [ ] 4 [ ] 4 | FOREIGN NATION | [ ] 6 [ ] 6 | PLAINTIFF(S) ADDRESS(ES) AND COUNTY(IES) Jane Doe\ Nassau County, New York\ c/o Kaplan Hecker & Fink LLP\ 350 Fifth Avenue, Suite 7110, New York, NY 10118 DEFENDANT(S) ADDRESS(ES) AND COUNTY(IES) DEFENDANT(S) ADDRESS UNKNOWN REPRESENTATION IS HEREBY MADE THAT, AT THIS TIME, I HAVE BEEN UNABLE, WITH REASONABLE DILIGENCE, TO ASCERTAIN THE RESIDENCE ADDRESSES OF THE FOLLOWING DEFENDANTS: Defendants are sued as executors of the Estate of Jeffrey Epstein. Per 28 USC 1332, Defendants are deemed citizens of the U.S. Virgin Islands (USVI), decedent Epstein's domicile. Defendants' residential addresses are unknown to Plaintiff. Defendants' counsel listed above. **COURTHOUSE ASSIGNMENT** I hereby certify that this case should be assigned to the courthouse indicated below pursuant to Local Rule for Division of Business 18, 20 or 21. Check one: THIS ACTION SHOULD BE ASSIGNED TO: PLAINS MANHATTAN DATE 9/19/2019 SIGNATURE OF ATTORNEY OF RECORD ![](<>)ADMITTED TO PRACTICE IN THIS DISTRICT [ ] NO RECEIPT # [X] YES (DATE ADMITTED Mo.05 Yr. 1993 )\ Attorney Bar Code # Magistrate Judge is to be designated by the Clerk of the Court. Magistrate Judge \_\_\_\_\_ is so Designated.