Fill and Sign the Information Court Form

IN THE CIRCUIT COURT FOR       (City or County) CIVIL–DOMESTIC CASE INFORMATION REPORT DIRECTIONS Plaintiff: This Information Report must be completed and attached to the complaint filed with the Clerk of Court unless your case is exempted from the requirement by the Chief Judge of the Court of Appeals pursuant to Rule 2-111(a). Defendant: You must file an Information Report as required by Rule 2-323(h). THIS INFORMATION REPORT CANNOT BE ACCEPTED AS A PLEADING FORM FILED BY: PLAINTIFF DEFENDANT CASE NUMBER       (Clerk to insert) CASE NAME:       vs.       Plaintiff Defendant PARTY’S NAME:       PHONE:       PARTY’S ADDRESS:       PARTY’S E-MAIL:       If represented by an attorney: PARTY’S ATTORNEY’S NAME :       PHONE : (       )       PARTY’S ATTORNEY’S ADDRESS :       PARTY’S ATTORNEY’S E-MAIL :       I am not represented by an attorney RELATED CASE PENDING? Yes No If yes, Court and Case #(s), if known:       PLEADING TYPE New Case: Original Existing Case: Post-Judgment Amendment If filing in an existing case , skip Case Category/ Subcategory section - go to Issues section. SPECIAL REQUIREMENTS? Spoken Language Interpreter - Attach form CC-DC-041 If you require an accommodation for a disability under the Americans with Disabilities Act - Attach form CC-DC-049 ALTERNATIVE DISPUTE RESOLUTION INFORMATION Is this case appropriate for referral to an ADR process under Md. Rule 17-101? (Check all that apply) A. Mediation Yes No C. Settlement Conference Yes No B. Arbitration Yes No D. Neutral Evaluation Yes No If no, explain why: Petition for Name Change IF NEW CASE: CASE CATEGORY/SUBCATEGORY ( Check one box. ) Domestic Family Alimony/Spousal Support Agency/IV-D Change of Name Independent Proceedings Annulment Child Support Change of Name Amend Birth Certificate Breach Paternity/Parentage Adult Change of Sex Child Support – Private UIFSA Minor Correct Death Certificate Custody Declare Deceased Divorce Adoption Dispose Body Emancipation Adoption – Independent Amend Marriage Certificate Enforce Foreign Order Adoption – Private Agency Family Legal/Medical Guardianship Paternity/Parentage Guardianship of Adult Person and/or Property Recognition as Legal Child Guardianship of Minor Person and/or Property Visitation IF NEW OR EXISTING CASE: ISSUES (Check All that Apply) CC-DCM-001 (Rev. 04/2017) Page 1 of 2 Adoption Change of Name Earnings Withholding Pension Distribution Alimony/Spousal Support Adult Emancipation Property Distribution Permanent Minor Enforcement Protective Order Rehabilitative Change of Sex Exceptions Register Foreign Order Amend Birth Certificate Child Support Family Legal/Medical Restore Former Name Amend Death Certificate Contempt Gdnshp of Adult Termination of Gdnshp Amend Marriage Certificate Court Costs/Fees Person Transaction Review Annulment Custody Property Use and Possession Asset Determination Declare Deceased Gdnshp of Minor Visitation Change of Name Dispose Body Person Adult Divorce Absolute Property Minor Divorce Limited Paternity/Parentage ESTIMATED LENGTH OF HEARING (Case will be tracked accordingly) Time Estimate for a Merits Hearing:       Hours       Days Time Estimate for hearing other than Merits Hearing:       Hours       Days OTHER MATTERS IS THIS CASE CONTESTED: Yes No If yes, which issues appear to be contested? Ground for divorce Child Custody Visitation Child Support Alimony Permanent Rehabilitative Use and possession of family home and property Marital property issues involving: Valuation of business Pensions Bank accounts/IRA’s Real Property Other:       Paternity Adoption/termination of parental rights Other:       Request is made for: Initial Order Modification Contempt Absolute Divorce Limited Divorce For non-custody/visitation issues, do you intend to request: Court-appointed expert (name field)       Initial conference with the Court Mediation by a Court-sponsored settlement program Other :       For custody/visitation issues, do you intend to request: Mediation by a private mediator Appointment of counsel to represent child Evaluation by mental health professional (not just to waive psychiatric privilege) Other Evaluation       A conference with the Court       Is there an allegation of physical or sexual abuse of party or child? Yes No Date Signature of Counsel / Party Address Printed Name City State Zip Code CC-DCM-001 (Rev. 04/2017) Page 2 of 2