Information Sheet

Superior Court of the District of Columbia CIVIL DIVISION - CIVIL ACTIONS BRANCH INFORMATION SHEET Case Number: ________________________ _________________________________________________________________ vs Date: ___________________________ ____________________________________________ One of the defendants is being sued in their official capacity. Relationship to Lawsuit Attorney for Plaintiff Name: (please print) Firm Name: Self (Pro Se) Other: _____________________ Telephone No.: Six digit Unified Bar No.: TYPE OF CASE: Non-Jury Demand:$ ___________________________ 6 Person Jury 12 Person Jury Other: _______________________________________________ PENDING CASE(S) RELATED TO THE ACTION BEING FILED Case No.: ______________________ Judge: _____________________________ Calendar #: _____________________ Case No.: ______________________ Judge: _____________________________ Calendar #: _____________________ NATURE OF SUIT: (Check One Box Only) A. CONTRACTS 01 Breach of Contract 02 Breach of Warranty 06 Negotiable Instrument 15 _________________ 07 Personal Property 09 Real Property-Real Estate 12 Specific Performance COLLECTION CASES 14 Under $25,000 Pltf. Grants Consent 16 Under $25,000 Consent Denied 17 OVER $25,000 Pltf. Grants Consent B. PROPERTY TORTS 01 Automobile 02 Conversion 07 Shoplifting, D.C. Code § 27-102(a) 03 Destruction of Private Property 04 Property Damage 05 Trespass 06 Traffic Adjudication 09 Harassment 10 Invasion of Privacy 11 Libel and Slander 12 Malicious Interference 13 Malicious Prosecution 14 Malpractice Legal 15 Malpractice Medical (Including wrongful death) 16 Negligence-(Not Automobile, 17 Personal Injury – (Not Automobile, C. PERSONAL TORTS 01 Abuse of Process 02 Alienation of Affection 03 Assault and Battery 04 Automobile-Personal Injury 05 Deceit (Misrepresentation) 06 False Accusation 07 False Arrest 08 Fraud Not Malpractice) SEE REVERSE SIDE AND CHECK HERE Not Malpractice) 18 Wrongful Death (Not malpractice) 19 Wrongful Eviction 20 Friendly Suit 21 Asbestos 22 Toxic/Mass Torts 23 Tobacco 24 Lead Paint IF USED CV-496/October 2010 American LegalNet, Inc. www.FormsWorkFlow.com INFORMATION SHEET, Continued D. OTHERS I. 01 Accounting 02 Att. Before Judgment 04 Condemnation (Emin. Domain) 05 Ejectment 07 Insurance/Subrogation Under $25,000 Pltf. Grants Consent 08 Quiet Title 09 Special Writ/Warrants DC Code § 11-941 10 T.R.O./Injunction 11 Writ of Replevin 12 Enforce Mechanics Lien 16 Declaratory Judgment 17 Merit Personnel Act (OEA) (D.C. Code Title 1, Chapter 6) 18 Product Liability 24 Application to Confirm, Modify, Vacate Arbitration Award (D.C. Code § 16-4315) 25 Liens: Tax/Water Consent Granted 26 Insurance/Subrogation Under $25,000 Consent Denied 27 Insurance/Subrogation Over $25,000 28 Motion to Confirm Arbitration Award (Collection Cases Only) 26 Merit Personnel Act (OHR) 30 Liens: Tax/Water Consent Denied 15 Libel of Information 19 Enter Administrative Order as Judgment [D.C. Code § 2-1802.03(h) or 32-1519(a)] 20 Master Meter (D.C. Code § 42-3301, et seq.) 21 Petition for Subpoena [Rule 28-I (b)] 22 Release Mechanics Lien 23 Rule 27 (a)(1) (Perpetuate Testimony) II. 03 Change of Name 06 Foreign Judgment 13 Correction of Birth Certificate 14 Correction of Marriage Certificate For individuals not represented by an attorney: ( ) I acknowledge receipt of the Civil Actions Pro Se Handbook. ____________________________________ Signature _______________________ Date CV-496/October 2010 American LegalNet, Inc. www.FormsWorkFlow.com