American LegalNet, Inc. www.FormsWorkFlow.com SIXTEENTH JUDICIAL CIRCUIT COURT OF JACKSON COUNTYat Kansas Cityat Independence Service Instruction for each defendant listed:Jackson County: Private Process Out of County--Provide info belowSheriff Name/Address: PARTY PLAINTIFF/PETITIONER Last Name:First Name:Middle Initial:Social Security Number:Address:City:State:Zip: PARTY DEFENDANT/RESPONDENT Last Name:First Name:Middle Initial:Social Security Number:Address:City:State:Zip: LEAD ATTORNEY OF RECORD-PLAINTIFF/PRO SE Last Name:First Name:Middle Initial:Address:City:State:Zip:Phone #:Fax #:MO Bar Number:E-Mail: LEAD ATTORNEY OF RECORD-DEFENDANT (if known) Last Name:First Name:Middle Initial:Address:City:State:Zip:MO Bar Number:E-Mail: CIVIL FILING INFORMATION SHEETCASE #: file stamp here CIRCUIT CIVIL CASE INFORMATION Case Track:Expedited: (Out of state witness, injunction, TRO, extraordinary remedy, replevins, etc.)StandardComplex: (Asbestos, tobacco, or other cases that will likely take more than 2 weeks to try)Case Type Description:Case Type Code: Court Rule 3.1.4-Case Type Code--See Civil Case Codes on Reverse andunder the forms section of the Court222s website at www.16thcircuit.org OTHER IMPORTANT INFORMATION Review Division-Specific Information on the Court222s 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 Administrator222soffice. Date:Attorney/Pro Se Signature:Form 4 CONFIDENTIAL DOCUMENTCIRCT A1253 8/18/09 DO NOT KEEP IN COURT FILE