COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: DOMESTIC RELATIONS 6/1/2017 The domestic relations reporting form and the information contained herein shall not be admissible as evidence in any other court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law of Supreme Court Rule. This form is required pursuant to Administrative Order Number 8. Instructions are located at www.courts.arkansas.gov . County: District: Filing Date: Judge: Division: Case ID: Type of Case (select only one): (AN) Annulment (marriage date: ) -Domestic Relations (marriage date: ) (FJ) Foreign Judgment-Domestic Relations Order of Protection (marriage date: ) SS) Support (OCSE) ST) Support-Private (non-OCSE) SU) Support-UIFSA ) Does this case involve the custody or support of minor children? If yes, also file the completed Confidential Information Sheet. Plaintiff Defendant Last Name Last Name Suffix Suffix First Name First Name DL/State ID DL/State ID Address Address City, State , ZIP City, State , ZIP Phone Phone Email Email Self - represented Self - represented DOB DOB Interpreter needed? (language) Interpreter needed? (language) Attorney of Record: Bar #: For the: Email Address: Related Case(s): Judge: Case ID(s): Manner of filing: type) Re-open ) Reactivate American LegalNet, Inc. www.FormsWorkFlow.com