IN THE CIRCUIT COURT FOR (City or County) CIVIL - DOMESTIC CASE INFORMATION REPORT DIRECTIONS Plaintiff: This Information Report must be completed and attached to the complaint filed with the Clerk of Court unless your case is exempted from the requirement by the Chief Judge of the Court of Appeals pursuant to Rule 2-111(a). Defendant: You must file an Information Report as required by Rule 2-323(h). THIS INFORMATION REPORT CANNOT BE ACCEPTED AS A PLEADING FORM FILED BY: CASE NAME: PARTY'S NAME: PARTY'S ADDRESS: PARTY'S E-MAIL: If represented by an attorney: PLAINTIFF Plaintiff DEFENDANT CASE NUMBER vs. (Clerk to insert) Defendant PHONE: PARTY'S ATTORNEY'S NAME: PHONE: PARTY'S ATTORNEY'S ADDRESS: PARTY'S ATTORNEY'S E-MAIL: I am not represented by an attorney RELATED CASE PENDING? Yes No If yes, Case #(s), if known: PLEADING TYPE New Case: Original Existing Case: Post-Judgment Amendment If filing in an existing case, skip Case Category/ Subcategory section - go to Issues section. SPECIAL REQUIREMENTS Spoken Language Interpreter - Attach form CC-DC-041 If you require an accommodation for a disability under the Americans with Disabilities Act - Attach form CC-DC-049 ALTERNATIVE DISPUTE RESOLUTION INFORMATION Is this case appropriate for referral to an ADR process under Md. Rule 17-101? (Check all that apply) A. Mediation Yes No C. Settlement Conference Yes No B. Arbitration Yes No D. Neutral Evaluation Yes No If no, explain why: IF NEW CASE: CASE CATEGORY/SUBCATEGORY (Check one box.) Domestic Family Change of Name Independent Proceedings Alimony/Spousal Support Agency/IV-D Change of Name Amend Birth Certificate Child Support Annulment Change of Sex Paternity/Parentage Adult Breach Correct Death Certificate UIFSA Minor Child Support - Private Declare Deceased Custody Adoption Divorce Dispose Body Adoption - Independent Emancipation Amend Marriage Certificate Adoption - Private Agency Enforce Foreign Order Family Legal/Medical Guardianship Paternity/Parentage Guardianship of Adult Person and/or Property Recognition as Legal Child Guardianship of Minor Person and/or Property Visitation CC-DCM-001 (Rev. 04/2017) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com IF NEW OR EXISTING CASE: ISSUES (Check All that Apply) Adoption Alimony/Spousal Support Permanent Rehabilitative Amend Birth Certificate Amend Death Certificate Amend Marriage Certificate Annulment Asset Determination Change of Name Adult Minor Change of Name Adult Minor Change of Sex Child Support Contempt Court Costs/Fees Custody Declare Deceased Dispose Body Divorce - Absolute Divorce - Limited Earnings Withholding Emancipation Enforcement Exceptions Family Legal/Medical Gdnshp of Adult Person Property Gdnshp of Minor Person Property Paternity/Parentage Pension Distribution Property Distribution Protective Order Register Foreign Order Restore Former Name Termination of Gdnshp Transaction Review Use and Possession Visitation ESTIMATED LENGTH OF HEARING (Case will be tracked accordingly.) Time estimate for a Merits Hearing: Hours Time estimate for hearing other than a Merits Hearing: Hours IS THIS CASE CONTESTED? Ground for divorce Child Custody Visitation Child Support Alimony Permanent Rehabilitative Use and possession of family home and property Marital property issues involving: Valuation of business Pensions Bank accounts/IRA's Other: Paternity Adoption/termination of parental rights Other: Request is made for: Days Days OTHER MATTERS Yes No If yes, which issues appear to be contested? Real Property Initial Order Modification Contempt Absolute Divorce Limited Divorce For non-custody/visitation issues, do you intend to request: Court-appointed expert (name field) Initial conference with the Court Mediation by a Court-sponsored settlement program Other: For custody/visitation issues, do you intend to request: Mediation by a private mediator Appointment of counsel to represent child Evaluation by mental health professional (not just to waive psychiatric privilege) Other Evaluation A conference with the Court Is there an allegation of physical or sexual abuse of party or child? Date Address City CC-DCM-001 (Rev. 04/2017) State Zip Code Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Yes No Signature of Counsel / Party Printed Name