STATE OF INDIANA COUNTY OF________ ) IN THE ___________________________ COURT ) SS: ) Case Number: (To be supplied by Clerk when case is filed.) (Caption) APPEARANCE BY ATTORNEY IN CIVIL CASE This Appearance Form must be filed on behalf of every party in a civil case. 1. The party on whose behalf this form is being filed is: Initiating ____ Responding ____ Intervening ____ ; and the undersigned attorney and all attorneys listed on this form now appear in this case for the following parties: Name of party___________________________________________________ Address of party (see Question # 6 below if this case involves a protection from abuse order, a workplace violence restraining order, or a no-contact order) _______________________________________________________________________ _______________________________________________________________________ Telephone # of party _____________________________________ (List on a continuation page additional parties this attorney represents in this case.) 2. Attorney information for service as required by Trial Rule 5(B)(2) Name: ____________________________ Atty Number: __________________ Address: ___________________________________________________________ ___________________________________________________________________ Phone: _____________________________________________________________ FAX: ______________________________________________________________ Email Address: ______________________________________________________ (List on continuation page additional attorneys appearing for above party) 3. 4. This is a __________ case type as defined in administrative Rule 8(B)(3). I will accept service by: FAX at the above noted number: Yes ____ No ____ Page 1 of 3 Form TCM-TR3.1-1 Revised by State Court Administration 07/09 American LegalNet, Inc. www.FormsWorkFlow.com Email at the above noted number: Yes ____ No ____ 5. This case involves child support issues. Yes ____ No ____ (If yes, supply social security numbers for all family members on a separately attached document filed as confidential information on light green paper. Use Form TCM-TR3.1-4.) 6. This case involves a protection from abuse order, a workplace violence restraining order, or a no ­ contact order. Yes ____ No ____ (If Yes, the initiating party must provide an address for the purpose of legal service but that address should not be one that exposes the whereabouts of a petitioner.) The party shall use the following address for purposes of legal service: ________ ________ Attorney's address The Attorney General Confidentiality program address (contact the Attorney General at 1-800-321-1907 or e-mail address is confidential@atg.state.in.us). Another address (provide) ________ ______________________________________________________________ 7. This case involves a petition for involuntary commitment. Yes ____ No ____ 8. If Yes above, provide the following regarding the individual subject to the petition for involuntary commitment: a. Name of the individual subject to the petition for involuntary commitment if it is not already provided in #1 above: ____________________________________________ b. State of Residence of person subject to petition: _______________ c. At least one of the following pieces of identifying information: (i) Date of Birth ___________ (ii) Driver's License Number ______________________ State where issued _____________ Expiration date __________ (iii) State ID number ____________________________ State where issued _____________ Expiration date ___________ (iv) FBI number __________________________ (v) Indiana Department of Corrections Number _______________________ (vi) Social Security Number is available and is being provided in an attached confidential document Yes ____ No ____ 9. There are related cases: Yes ____ No ____ (If yes, list on continuation page.) 10. Additional information required by local rule: _____________________________________________________________________ Page 2 of 3 Form TCM-TR3.1-1 Revised by State Court Administration 07/09 American LegalNet, Inc. www.FormsWorkFlow.com 11. There are other party members: Yes ____ No____ (If yes, list on continuation page.) 12. This form has been served on all other parties and Certificate of Service is attached: Yes___ No___ _________________________________________ Attorney-at-Law (Attorney information shown above.) Page 3 of 3 Form TCM-TR3.1-1 Revised by State Court Administration 07/09 American LegalNet, Inc. www.FormsWorkFlow.com