LOUISIANA CIVIL CASE REPORTING Civil Case Cover Sheet - LA. R.S. 13:4688 and Part G, �13, Louisiana Supreme Court General Administrative Rules This civil case cover sheet shall be completed by counsel for the petitioner, counsel's authorized representative, or by the self-represented litigant (if not represented by counsel) and submitted with the original petition filed with the court. The information should be the best available at the time of filing. This information does not constitute a discovery request, response or supplementation, and is not admissible at trial. Suit Caption: vs. Court: ___________________________ Parish of Filing:____________________ Docket Number: _____________________ Filing Date: _________________________ Name of Lead Petitioner's Attorney: ________________________________________ Name of Self-Represented Litigant:__________________________________________ Number of named petitioners: _____ Number of named defendants: ____ Type of Lawsuit: Please check the categories which most appropriately apply to this suit (no more than 3 categories should be checked): __Auto: Personal Injury __ Auto: Property Damage __Auto: Wrongful Death __ Auto: Uninsured Motorist __Asbestos: Property Damage __ Asbestos: Personal Injury/Death __Product Liability __ Premise Liability __Intentional Bodily Injury __ Intentional Property Damage __Intentional Wrongful Death __ Unfair Business Practice __Business Tort __ Fraud __Defamation __ Professional Negligence __Environmental Tort __ Medical Malpractice __ Intellectual Property __ Toxic Tort __ Legal Malpractice __ Other Tort (describe below) __ Other Professional Malpractice __ Redhibition __ Maritime __ Class action (nature of case) __ Wrongful Death ______________________________________ __General Negligence Please briefly describe the nature of the litigation in one sentence of additional detail: ___________________________________________________________________________ ___________________________________________________________________________ Following the completion of this form by counsel, counsel's representative, or by the self-represented litigant, this document will be submitted to the Office of the Judicial Administrator, Supreme Court of Louisiana, by the Clerk of Court. Name, address and contact information of person completing form: Name ________________________________Signature______________________________________ Address ____________________________________________________________________________ Phone number:________________________E-mail address:__________________________________ American LegalNet, Inc. www.FormsWorkFlow.com