SIXTEENTH JUDICIAL CIRCUIT COURT OF JACKSON COUNTY CIVIL FILING INFORMATION SHEET at Kansas City at Independence file stamp here CASE #: PARTY PLAINTIFF/PETITIONER LEAD ATTORNEY OF RECORD-PLAINTIFF/PRO SE Last Name: Last Name: First Name: Middle Initial: First Name: Middle Initial: Social Security Number: Address: Address: City: State: Phone #: Fax #: MO Bar Number: E-Mail: City: State: Zip: Zip: PARTY DEFENDANT/RESPONDENT LEAD ATTORNEY OF RECORD-DEFENDANT (if known) Last Name: Last Name: First Name: Middle Initial: First Name: Middle Initial: Social Security Number: Address: Address: City: State: MO Bar Number: E-Mail: City: State: Zip: Zip: Service Instruction for each defendant listed: Jackson County: Private Process Out of County--Provide info below Sheriff Name/Address: CIRCUIT CIVIL CASE INFORMATION Case Track: Case Type Description: Expedited: (Out of state witness, injunction, TRO, extraordinary remedy, replevins, etc.) Case Type Code: Court Rule 3.1.4-Case Type Code--See Civil Case Codes on Reverse and under the forms section of the Court’s website at www.16thcircuit.org Standard Complex: (Asbestos, tobacco, or other cases that will likely take more than 2 weeks to try) OTHER IMPORTANT INFORMATION Review Division-Specific Information on the Court’s website to understand the requirements in processing your case--www.16thcircuit.org Court Rule 4.2 requires that this form must be complete and include a filing deposit or your petition will not be accepted for filing Court Rule 3.5 Designated Lead Attorney requires that each party is responsible for keeping the designated lead attorney information current Court Rule 21.9 Attorney Change of Address/Facsimile requires each attorney to keep their address, etc. up dated with the Court Administrator’s office. Date: Attorney/Pro Se Signature: Form 4 CIRCT A1253 8/18/09 CONFIDENTIAL DOCUMENT DO NOT KEEP IN COURT FILE American LegalNet, Inc. www.FormsWorkFlow.com