FORM 86-1 STATE OF INDIANA COUNTY OF________ ) IN THE ___________________________ COURT ) SS: ) Case Number: (To be supplied by Clerk when case is filed.) (Caption) E-FILING 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 # 5 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: ______________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com IMPORTANT: Each attorney specified on this appearance: certifies that the contact information listed for him/her on the Indiana Supreme Court Roll of Attorneys is current and accurate as of the date of this Appearance; (b) acknowledges that all orders, opinions, and notices from the court in this matter that are served under Trial Rule 86(G) will be sent to the attorney at the email address(es) specified by the attorney on the Roll of Attorneys regardless of the contact information listed above for the attorney; and (c) understands that he/she is solely responsible for keeping his/her Roll of Attorneys contact information current and accurate, see Ind. Admis. Disc. R. 2(A). Attorneys can review and update their Roll of Attorneys contact information on the Courts Portal at http://portal.courts.in.gov. 3. This is a __________ case type as defined in administrative Rule 8(B)(3). 4. 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.) 5. 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) __________________________________________________________ This case involves a petition for involuntary commitment. Yes ____ No ____ 6. 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: ____________________________________________ (a) ________ b. State of Residence of person subject to petition: _______________ c. At least one of the following pieces of identifying information: American LegalNet, Inc. www.FormsWorkFlow.com (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 ____ 7. There are related cases: Yes ____ No ____ (If yes, list on continuation page.) 8. Additional information required by local rule: _____________________________________________________________________ 9. There are other party members: Yes ____ No____ (If yes, list on continuation page.) 10. This form has been served on all other parties and Certificate of Service is attached: Yes___ No___ _________________________________________ Attorney-at-Law (Attorney information shown above.) American LegalNet, Inc. www.FormsWorkFlow.com