Civil Filing Information Sheet

SIXTEENTH JUDICIAL CIRCUIT COURT OF JACKSON COUNTY CIVIL FILING INFORMATION SHEET at Kansas City at Independence CASE #: PARTY PLAINTIFF/PETITIONER Last Name: First Name: Last FOUR digits of Social Security Number: Address: City: State: Zip: Middle Initial: file stamp here LEAD ATTORNEY OF RECORD-PLAINTIFF/PRO SE Last Name: First Name: Address: City: Phone #: MO Bar Number: State: Fax #: E-Mail: Zip: Middle Initial: PARTY DEFENDANT/RESPONDENT Last Name: First Name: Last FOUR digits of Social Security Number: Address: City: State: Zip: Middle Initial: LEAD ATTORNEY OF RECORD-DEFENDANT (if known) Last Name: First Name: Address: City: MO Bar Number: State: E-Mail: Zip: Middle Initial: Service Instruction for each defendant listed: Jackson County: Private Process Out of County--Provide info below Sheriff Name/Address: CIRCUIT CIVIL CASE INFORMATION Case Type Description: Case Type Code: Court Rule 3.1.4-Case Type Code--See Civil Case Codes on Reverse and under the forms section of the Court's website at www.16thcircuit.org Case Track: Expedited: (Out of state witness, injunction, TRO, extraordinary remedy, replevins, etc.) Standard Complex: (Asbestos, tobacco, or other cases that will likely take more than 2 weeks to try) OTHER IMPORTANT INFORMATION Review Division-Specific Information on the Court's website to understand the requirements in processing your case--www.16thcircuit.org Court Rule 4.2 requires that this form must be complete and include a filing deposit or your petition will not be accepted for filing Court Rule 3.5 Designated Lead Attorney requires that each party is responsible for keeping the designated lead attorney information current Court Rule 21.9 Attorney Change of Address/Facsimile requires each attorney to keep their address, etc. up dated with the Court Administrator's office. Date: Form 4 CIRCT A1253 Attorney/Pro Se Signature: 4/12/05 American LegalNet, Inc. www.USCourtForms.com