Fill and Sign the Important Notice in Order to File a Case You Must Have Form

STATE OF INDIANA ) IN THE ___________________________ COURT ) SS : COUNTY OF________ ) Case Number: (To be supplied by Clerk when case is filed.) (Caption) APPEARANCE BY ATTORNEY IN CIVIL CASE This Appearance Form must be filed on behalf of e very party in a civil case. 1. The party on whose behalf this form is being filed is: Initiating ____ Responding ____ Intervening ___ __; and the undersigned attorney and all attorneys listed on this form now appear in this case for the following pa rties: Name of party___________________________________________________ Address of party (see Question # 6 below if this case involves a protection from abuse order, a workplace violence restraining order, or a no -contact order) _______________________ ________________________________________________ _______________________________________________________________________ Telephone # of party _____________________________________ FAX: Email Address: (List on a continuation page additional parties this attorney represents in this case.) 2. Attorney information for service as required by Trial Rule 5(B)(2) Name: _____ _______________________ Atty Number: __________________ Address: __________________________________ _________________________ ___________ _________________________________ _______________________ Phone: _______________________ ______________________________________ FAX : ______________________________________________________________ Email Address: ____________________________________________ __________ (List on continuation page additional attorneys appearing for above party) 3. This is a __________ case type as defined in administrative Rule 8(B)(3). 4. I will accept service from other parties by : FAX at the above noted number: Yes ____ No __ __ Email at the above noted number: Yes ____ No ____ 5. This case involves child support issues. Yes ____ No ____ (If yes, supply social security numbers for all family members on a separately attached document filed as confidential information on light green paper . Use Form TCM -TR3.1 -4.) 6. This case involves a protection from abuse order, a workplace violence restraining order, or a no – contact order. Yes ____ No ____ (If Yes, the initiating party must provide an address for the purpose of legal servi ce but that address should not be one that exposes the whereabouts of a petitioner.) The party shall use the following address for purposes of legal service: ________ Attorney’s address ________ The Attorney General Confidentiality program address (contact the Attorney General at 1-800 -321 -1907 or e -mail address is confidential@atg.in. gov ). ________ Another address (provide) ______________________________________________________________ 7. This case involves a petition for involuntary co mmitment. Yes ____ No ____ 8. If Yes above, provide the following regarding the individual subject to the petition for involuntary commitment: a. Name of the individual subject to the petition for involuntary commitment if it is not already provided in #1 abov e: ____________________________________________ b. State of Residence of person subject to petition: _______________ c. At least one of the following pieces of identifying information: (i) Date of Birth _________ __ (ii) Driver’s License Number ____ __ ________________ State where issued ___ _______ ___ Expiration date __________ (iii) State ID number _____________ _______________ State where issued _______ ______ Expiration date ___________ (iv) FBI number ______________ ____________ (v) Indiana Departme nt of Corrections Number _____________ __________ (vi) Socia l Security Number is available and is being provided in an attached confidential document Yes ____ No ____ 9. There are related cases: Yes ____ No ____ (If yes, list on continuation page.) 10 . Additional information required by local rule: _______________________________________ ______________________________ 11. There are other party members: Yes ____ No____ (If yes, list on continuation page.) 12 . This form has been served on all other parti es and Certificate of Service is attached: Yes___ No___ _________________________________________ Attorney -at-Law (Attorney information shown above.)