Fill and Sign the Pennsylvania Civil Form

      COUNTY COURT OF COMMON PLEAS CIVIL COVER SHEET Docket No.       I(a) PLAINTIFFS       DEFENDANTS       (b) PLAINTIFF’S ATTORNEY (ADDRESS)             DEFENDANT’S ATTORNEY (IF KNOWN) (ADDRESS)             II. MANDATORY ARBITRATION Does this fall under the mandatory arbitration requirements per Local Rule 1301? Yes No III. ALTERNATIVE DISPUTE RESOLUTION REQUESTED Summary Jury Trial Other: See “Guide to Alternative Dispute Resolution Programs” Published by the       County Bar Association. IV. CAUSE(S) OF ACTION (Cite the statutes or rules of law under which you are filing and write a brief statement of cause(s).) Divorce Code 3301 (c) or (d) V. GENERAL NATURE OF SUIT (Place an x in one area only that most accurately describes your case) CONTRACT PERSONAL INJURY DOMESTIC RELATIONS Insurance Motor Vehicle Divorce PA Bond Product Liability Protection from Abuse Collection Suits Medical Malpractice Custody/Visitation Construction Other Prof. Liability Other – List in IV above Other – List in Intentional Support IV above Premises Other – List in IV above REAL PROPERTY PRISONER PETITIONS OTHER STATUTES Condemnation Habeas Corpus Zoning Appeal Foreclosure Mandamus School Board Appeal Landlord & Tenant Other – List in License Suspension Appeal Partition IV above Assessment Appeal Mechanics’ Lien Other – List in IV above Environment Other – List in LABOR TAX LIEN & IV above TAX MATTERS Address of Property       OTHER List in IV above (a) Is this any equity case? Yes No (b) Does it involve a governmental body? Yes No VI. ORIGIN (Mark only 1) 1 Original 2 Removed from 3 Confessed 4 Transferred 5 Appeal 6 Appeal to 7 Foreign Complaint Federal Court Judgments by From Another From court from Judgment of Writ Complaint District or Govt. district judge or Praecipe County (specify) Agency judgment VII. REQUESTED IN COMPAINT (a) Is this a CLASS ACTION Yes or No (b) Circle YES only if jury demanded in complaint: JUERY DEMAND: YES or NO (c) Amount demanded in complaint       Will you accept 6 jurors? YES or NO VIII. RELATED CASE(S) IF ANY JUDGE       DOCKET NUMBER       Case Caption __________________________ _____________________________________________ Date SIGNATURE OF FILING PARTY OR ATTORNEY OF RECORD