In The Court of Common Pleas Tuscarawas County, Ohio General Trial Division Civil Case Designation Form _________________________________________ Address: __________________________________ _________________________________________ Plaintiff(s), vs. _________________________________________ Address: __________________________________ _________________________________________ Defendant(s). : : : : : : : : : : : : Case Number: ________________________ Judge: _______________________________ Has this case been previously filed and dismissed? Check one: _____ Yes _____ No If yes, list case number and judge: _____________________________________________ List all related pending case(s), including case number and judge: ________________________________ Please indicate which category and subcategory, if applicable. _____ A. Professional Tort _____ Medical Malpractice _____ Legal Malpractice _____ Other Malpractice Product Liability Other Tort _____ Personal Injury _____ Personal Injury - Auto _____ Consumer Protection _____ Miscellaneous _____ E. Foreclosure _____ Residential _____ Residential - Rental _____ Business/Commercial Administrative Appeal Complex Litigation Classification Requested Other Civil _____ Appropriation* to Ct Adm _____ Contract _____ Debt Collection _____ Stalking _____ Consumer Protection _____ Miscellaneous _____ Yes _____ No _____ B. _____ C. _____ F. _____ G. _____ H. _____ D. Workers Compensation Check one: Attorney: Mediation: Is this case appropriate for mediation? Non-attorney/pro se litigant: ____________________________________ Party Name (if not represented by an attorney) ________________________________________ Attorney of Record ____________________________________ Signature ________________________________________ Signature ____________________________________ Address ________________________________________ Attorney Registration Number ____________________________________ Address (continued) ________________________________________ Firm Name ________________________________________ ____________________________________ Home Telephone Firm Address ____________________________________ Cell Phone ________________________________________ ________________________________________ Firm Phone Number ____________________________________ Email Address __________________________________________ Attorney Email Address American LegalNet, Inc. www.FormsWorkFlow.com Revised 11/15