DISCLOSURE STATEMENT CLERK OF SUPERIOR COURT CASE NUMBER Assigned by Clerk PLAINTIFF VS. DEFENDANT TYPE OF ACTION 1. Divorce without Agreement Attached 11. URESA 2. Divorce with Agreement Attached 12. Name Change 3. Domestic Relations 13. Other 4. Damages arising out of Contract 14. Recusal 5. Damages arising out of Tort 15. Adoption 6. Condemnation 7. Equity 8. Zoning- County Ordinance violations (i.e. Injunctive relief-zoning) 9. Zoning Appeals (denovo) 10. Appeal, Including denovo appeal-excluding Zoning PREVIOUS RELATED CASES Does this case involve substantially the same parties, or substantially the same subject matter, or substantially the same factual issues, as any other case filled in this court? (Whether pending simultaneously or not.) NO YES 226 If yes please fill out the following: 1. Case # 2. Parties vs. 3. Assigned Judge 4. Is this case still pending? Yes No 5. Brief description of similarities: 001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001001002 Attorney or Party Filling Suit Form #0122 Revised 8/02/17 002 American LegalNet, Inc. www.FormsWorkFlow.com