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 copy must be included for each defendant to be served. Defendant: You must file an Information Report as required by Rule 2-323(h). THIS INFORMATION REPORT CANNOT BE ACCEPTED AS AN ANSWER OR RESPONSE FORM FILED BY: PLAINTIFF DEFENDANT CASE NUMBER Clerk to insert CASE NAME: vs. Plaintiff PHONE: ( PARTY'S NAME: Defendant ) - Day Time Phone ADDRESS: PHONE: ( PARTY'S ATTORNEY'S NAME: ATTORNEY'S ADDRESS: I am not represented by an attorney RELATED CASE PENDING? Yes No ) - If yes, Court and case #(s) if known: Special Requirements? Interpreter/communication impairment (Attach Form 1-332 if Accommodation or Interpreter Needed) ADA accommodation: Which language Which dialect 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 IS THIS CASE CONTESTED? Yes No If yes, which issues appear to be 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 Real Property Other: Paternity Adoption/termination of parental rights Other: Request is made for: Initial order Modification Contempt Absolute Divorce Limited Divorce For non-custody/visitation issues, do you intend to request: Court-appointed expert (name field) Mediation by a Court-sponsored settlement program Initial conference with the court Other: For custody/visitation issues, do you intend to request: Mediation by a private mediator Evaluation by mental health professional Other Evaluation Appointment of counsel to represent child (not just to waive psychiatric privilege) A conference with the Court Is there an allegation of physical or sexual abuse of party or child? CC/DCM 001 (Rev. 3/2009) Page 1 of 2 Yes No American LegalNet, Inc. www.FormsWorkFlow.com CASE NAME vs. CASE NUMBER: Defendant Plaintiff TIME ESTIMATE FOR A MERITS HEARING: (Clerk to Insert) hours TIME ESTIMATES FOR HEARING OTHER THAN A MERITS HEARING: days hours days COMPLEX SCIENCE MEDICAL CASE MANAGEMENT PROGRAM (ASTAR) FOR PURPOSES OF POSSIBLE SPECIAL ASSIGNMENT TO AN ASTAR RESOURCE JUDGE under Md. Rule 16-202. Please check the applicable box below and attach a duplicate copy of your complaint. Standard - Trial within 18 months of filing Expedited - Trial within 7 months of filing Signature of Counsel/Party Date Print Name Street Address City/State/Zip CC/DCM 001 (Rev. 3/2009) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com