Case Designation Form

FINDLAY MUNICIPAL COURT David C Spridgeon, Clerk of Court PO BOX 826 FINDLAY, OHIO 45839 419-424-7143 CASE DESIGNATION FORM (failure to complete this form may delay the processing of your claim) Case Number:__________________________________ 1. Has this case been previously filed and dismissed? Please check one. Yes ( ) No ( ) If yes, please indicate court, case number and judge. Court_______________ Case No. _________________ Judge____________ 2. Are there any related cases, pending or closed? Please check one. Yes ( ) No ( ) If yes, please indicate court, case number and judge. Court_______________ Case No. _________________ Judge____________ PURSUANT TO THE REQUIREMENTS AND SANCTIONS PROVIDED WITHIN RULE 11 OF THE OHIO RULES OF CIVIL PROCEDURE, I HEREBY CERTIFY THE ABOVE TO BE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. Signature of Plaintiff or Attorney for Plaintiff 3. Do you believe that this case can be resolved through Mediation? Plaintiff (include complete name, address and phone #) Please check one. Yes ( ) No ( ) Defendant (include complete name, address and phone #) (If more space is necessary for additional parties please use the reverse side of this form) CIVIL CATEGORIES PLACE AN (X) IN ONE CATEGORY ONLY Unpaid Wages/Commission - CVF Reimbursement ­ CVF Compensatory/Punitive Damages - CVF Unpaid Credit Card Debt - CVF Return of Security Deposit ­ CVF Act for Declaratory Relief - CVF Unpaid Rent/Damages ­ CVF Replevin ­ CVF, CVH Small Claims ­ CVI Eviction Only - CVG Eviction with Rent/Damage Claim ­ CVG Other: Accident Auto Damage ­ CVE Intentional Tort ­ CVE Personal Injury ­ CVE Property Damage ­ CVE Account, Money Owed, Nonpayment of Services ­ CVF Bad Check ­ CVF Breach of Warranty/Contract ­ CVF Damage Due to Workmanship ­ CVF Default of Loan/Lease ­ CVF Dispute ­ CVF Unpaid Taxes - CVF Promissory Note ­ CVF Request for Regular Mail Service If service of process by Certified Mail is returned by the Postal Authorities with an endorsement of "REFUSED" OR "UNCLAIMED" the undersigned waives notice of this by the Clerk and requests ordinary mail service is accordance with Civil Rule 4.6(C) or 4.6(D). Signature of Plaintiff or Attorney for Plaintiff Attorney Information Attorney of Record (Please print or type) Ohio Supreme Court Number Address Firm Name City State Zip Telephone Number Fax Number American LegalNet, Inc. www.FormsWorkFlow.com