COVER SHEET Civil Case Filing Form (To be completed by Attorney/Party Prior to Filing of Pleading) Mississippi Supreme Court Administrative Office of Courts In the Form AOC/01 (Rev 2016) Court Identification Docket # County # Judicial District Court ID (CH, CI, CO) Case Year Docket Number Local Docket ID Month Date Year This area to be completed by clerk Court of County Case Number if filed prior to 1/1/94 Judicial District Other Origin of Suit (Place an "X" in one box only) Initial Filing Remanded Reinstated Reopened Foreign Judgment Enrolled Joining Suit/Action Transfer from Other court Appeal Plaintiff Party(ies) Initially Bringing Suit Should Be Entered First Enter Additional Plaintiffs on Separate Form Individual Last Name First Name Maiden Name, if applicable ____ Check ( x ) if Individual Plainitiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style: Estate of ____ Check ( x ) if Individual Planitiff is acting in capacity as Business Owner/Operator (d/b/a) or State Agency, and enter entity D/B/A or Agency Business Enter legal name of business, corporation, partnership, agency If Corporation, indicate the state where incorporated ____ Check ( x ) if Business Planitiff is filing suit in the name of an entity other than the above, and enter below: D/B/A Address of Plaintiff Attorney (Name & Address) ____ Check ( x ) if Individual Filing Initial Pleading is NOT an attorney Signature of Individual Filing: MS Bar No. M.I. Jr/Sr/III/IV Defendant Name of Defendant Enter Additional Defendants on Separate Form Individual Last Name First Name Maiden Name, if applicable ____ Check ( x ) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style: Estate of ____ Check ( x ) if Individual Defendant is acting in capacity as Business Owner/Operator (d/b/a) or State Agency, and enter entity: D/B/A or Agency Business Enter legal name of business, corporation, partnership, agency If Corporation, indicate the state where incorporated ____ Check ( x ) if Business Defendant is acting in the name of an entity other than the above, and enter below: D/B/A Attorney (Name & Address) If Known Check ( x ) if child support is contemplated as an issue in this suit.* *If checked, please submit completed Child Support Information Sheet with this Cover Sheet Business/Commercial Accounting (Business) Business Dissolution Debt Collection Employment Foreign Judgment Garnishment Replevin Other ___________________ Probate Accounting (Probate) Birth Certificate Correction Mental Health Commitment Conservatorship Guardianship Heirship Intestate Estate Minor's Settlement Muniment of Title Name Change Testate Estate Will Contest Alcohol/Drug Commitment (Involuntary) Alcohol/Drug Commitment (Voluntary) Other Children/Minors NonDomestic Adoption Contested Adoption Uncontested Consent to Abortion Minor Removal of Minority Other _____________________ Civil Rights Elections Expungement Habeas Corpus Post Conviction Relief/Prisoner Other _____________________ Contract Breach of Contract Installment Contract Insurance Specific Performance Other _____________________ Statutes/Rules Bond Validation Civil Forfeiture Declaratory Judgment Injunction or Restraining Order Other _____________________ MS Bar No. Real Property Adverse Possession Ejectment Eminent Domain Eviction Judicial Foreclosure Lien Assertion Partition Tax Sale: Confirm/Cancel Title Boundary or Easement Other __________________ Torts Bad Faith Fraud Intentional Tort Loss of Consortium Malpractice Legal Malpractice Medical Mass Tort Negligence General Negligence Motor Vehicle Premises Liability Product Liability M.I. Jr/Sr/III/IV Nature of Suit (Place an "X" in one box only) Domestic Relations Child Custody/Visitation Child Support Contempt Divorce:Fault Divorce: Irreconcilable Diff. Domestic Abuse Emancipation Modification Paternity Property Division Separate Maintenance Term. of Parental Rights-Chancery UIFSA (eff 7/1/97; formerly URESA) Other _____________________ Appeals Administrative Agency County Court Hardship Petition (Driver License) Justice Court MS Dept Employment Security Municipal Court Other _____________________ Subrogation Wrongful Death Other __________________ American LegalNet, Inc. www.FormsWorkFlow.com IN THE COURT OF JUDICIAL DISTRICT, CITY OF COUNTY, MISSISSIPPI Docket No. File Yr Chronological No. Clerk's Local ID Docket No. If Filed Prior to 1/1/94 PLAINTIFFS IN REFERENCED CAUSE - Page 1 of Plaintiffs Pages IN ADDITION TO PLAINTIFF SHOWN ON CIVIL CASE FILING FORM COVER SHEET Plaintiff #2: Individual: Last Name First Name ( Maiden Name, if Applicable ) Middle Init. Jr/Sr/III/IV ___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style: Estate of ___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below: D/B/A Business Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below: D/B/A ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T) Plaintiff #3: Individual: Last Name First Name ( Maiden Name, if Applicable ) Middle Init. Jr/Sr/III/IV ___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style: Estate of ___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below: D/B/A Business Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below: D/B/A ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T) Plaintiff #4: Individual: Last Name First Name ( Maiden Name, if Applicable ) Middle Init. Jr/Sr/III/IV ___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style: Estate of ___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below: D/B/A Business Enter legal name of business, corporation, partnership, agency - If C