COURT OF COMMON PLEAS CIVIL CASE INFORMATION STATEMENT (CIS) COUNTY: N K S Caption: CIVIL ACTION NUMBER:____________________ Civil Case Type: ___________________________ (SEE REVERSE SIDE FOR TYPE) Name and Status of party filing Document: DOCUMENT TYPE: (E.G.; COMPLAINT; ANSWER WITH COUNTERCLAIM) Non-Arbitration _______ (CERTIFICATE OF VALUE MAY BE REQUIRED) Arbitration ____ Mediation ____ Neutral Assessment ____ Defendant (Circle One) ACCEPT REJECT JURY DEMAND YES _____ NO _____ If Yes – please attach $185.00 filing fee for Superior Court Prothonotary ATTORNEY NAME(S): IDENTIFY ANY RELATED CASE(S) NO PENDING BY CAPTION AND CIVIL ACTION NUMBER: ATTORNEY ID(S): EXPLAIN THE RELATIONSHIP(S): FIRM NAME: ADDRESS: TELEPHONE NUMBER: (OTHER UNUSAL ISSUES THAT AFFECT CASE MANAGEMENT) FAX NUMBER: E-MAIL ADDRESS: (IF ADDITIONAL SPACE IS NEEDED, PLEASE ATTACH PAGE) WILL NOT PROCESS THE COMPLAINT, ANSWER, OR FIRST RESPONSIVE PLEADING IN THIS MATTER FOR SERVICE UNTIL THE CASE INFORMATION STATEMENT (CIS) IS FILED. THE FAILURE TO FILE THE CIS AND HAVE THE PLEADING PROCESSED FOR SERVICE MAY RESULT IN THE DISMISSAL OF THE COMPLAINT OR MAY RESULT IN THE ANSWER OR FIRST REPONSIVE PLEADING BEING STRICKEN. THE CLERK American LegalNet, Inc. www.FormsWorkFlow.com CIVIL CASE INFORMATION STATEMENT (CIS) INSTRUCTIONS CIVIL CASE TYPE Please select the appropriate case type from the list below. Enter the information in the designated spaces on the Case Information Statement. NEW CASTLE CCP – CIVIL Requested Type ________ TYPE KEYWORD TEXT DESCRIPTION ADMV ADMV ADMINISTRATIVE APPEAL FROM DIVISION OF MOTOR VEHICLES ARBC ARBC ARBITRATION CASE, $15,000.00 OR OVER * CARB CARB CONFIRMATION OF ARBITRATION AWARDS ON CONSUMER CREDIT CASES CCPC CCPC COURT OF COMMON PLEAS CASE – FILED FOR UNDER $15,000.00* CJPA CJPA JP APPEAL FILED WITH FEE CJPF CJPF JP APPEAL FILED WITHOUT FEE DOG DOG APPEAL FROM DECISION OF DOG CONTROL PANEL MHAB MHAB HABITUAL OFFENDER PETITION MNAM MNAM CHANGE OF NAME PETITION * CASE TYPES SUBJECT TO COURT OF COMMON PLEAS RULE 16 – ALTERNATIVE DISPUTE RESOLUTION DUTY OF THE PLAINTIFF Each plaintiff/counsel shall complete the attached Civil Case Information Statement (CIS) and file with the complaint. DUTY OF THE DEFENDANT Each defendant/counsel shall complete the attached Civil Case Information Statement (CIS) and file with the answer and/or first responsive pleading. American LegalNet, Inc. www.FormsWorkFlow.com