IN THE CIRCUIT COURT OF ST. LOUIS COUNTY, MISSOURI CIRCUIT CIVIL/ASSOCIATE CIVIL FILING INFORMATION SHEET INSTRUCTIONS FOR COMPLETING THE CIRCUIT CIVIL/ASSOCIATE CIVIL FILING INFORMATION SHEET: As part of our reporting requirements to the Missouri Supreme Court and the Office of the State Court Administrator, you are required to complete and submit this information sheet at the time you file your cause of action. Your cause of action will not be accepted and/or processed unless it is accompanied by this information sheet at the time of filing. The person, or attorney, filing the cause of action should the complete the form as follows: You must provide the following information below for the purpose of initiating case processing. SSN is required if the party is a person; exception can only be granted if the information is not reasonably available. Type or neatly print in black ink. Plaintiff(s)/Defendant(s): Enter the full names (last, first, middle initial) of plaintiff(s) and defendant(s). If the plaintiff or defendant is a: Corporation ­ Include the full name of the corporation. Government Agency ­ Use only the full name or standard abbreviations. Government Official ­ Identify the Agency and then the official, giving both title and name. NOTE: If there are multiple counts in the petition that are considered in two or more categories, it is the responsibility of the filing party to choose the one appropriate Case Type code. The assignment of the case is subject to review by the Presiding Judge. Based on that review, the case may be reassigned. CASE HEADING:___________________________________vs_______________________________________ st 1 Defendant 1st Plaintiff Fill in the two-letter Case Type code from the back of this form here: (one code only). Does this case result from the alleged REFUSAL to take a Blood or Breathalyzer test? PARTIES (attach a separate sheet to include additional parties) Party Type: Last Name: Middle Name: City: DOB: (i.e. Plaintiff,etc.) First Name: Address: __________________________________________ State: SSN: required Party Type: Last Name: Middle Name: City: DOB: Zip: YES Circle one NO (i.e. Plaintiff, Defendant, etc.) First Name: Address: __________________________________________ State: SSN: required Zip: ___ Attorney of Record Filing Action Address/City/State/Zip Code Phone Number F Bar # Firm ax Number E-mail address Signature of Person Filing CCCDT222 ­ JIS Revised 08/12 American LegalNet, Inc. www.FormsWorkFlow.com CASE TYPES LIST CATEGORY & CASE TYPE DESCRIPTION CONTRACT Breach of Contract Promissory Note Specific Performance Suit on Account Contract - Other AC Contract - BULK ADMINISTRATIVE REVIEW ­ NON DRIVERS LICENSE Chapter 536 State Agency Review Judicial Review DOR Dealer License COURT FILED IN CASE TYPE CODE ASSOCIATE CIRCUIT CM CA CN CB CO CC CP CD CQ CE CR ASSOCIATE CIRCUIT IA IG CATEGORY & CASE TYPE DESCRIPTION EXTRAORDINARY REMEDY (CONT.) Habeas Corpus Injunction EQ Other Extraordinary Remedy Show Cause to Enforce Jury Service ET Temporary Restraining Order MISCELLANEOUS CIVIL Action Against Garnishee CAFA Forfeit (513.600 - 513.640 RSMo) YB Common Law Lien Petition (428.115 RSMo) COURT FILED IN CASE TYPE CODE ASSOCIATE CIRCUIT EP EB EC ER ED EF EU EG ASSOCIATE CIRCUIT YA XA XB YC ADMINISTRATIVE REVIEW ­ DRIVERS LICENSE Chapter 536 State Agency Review ASSOCIATE CIRCUIT IN Drivers License Revocation Review (302.311 RSMo) Trial De Novo of DOR Decision Refused Breathalyzer (302.750/577.041 RSMo) Limited Driving Privileges (302.309 RSMo) Other Administrative Review SATOP Review (302.540/577.041 RSMo) TORTS AC Tort - BULK Employment Discrimination (213.111 RSMo) Public Accommodation (213.111 RSMo) Asbestos TQ Personal Injury - Federal Employee Liability Act Personal Injury - Malpractice Personal Injury ­ Product Liability IO IP IQ IR IS IT ASSOCIATE CIRCUIT TZ TO TP TK TJ TA Contempt YD Establishment of Charter Examination of Judgment Debtor Expungement/Correction of Arrest Record Expunge Criminal Records Out of State Witness Registration of Foreign Judgment (Excluding Domestic Relations) YE YF XD XE XF XG X5 XH XJ XK XL XM XN XO XP XQ XR XZ X1 XS XT XU XV XW XY NA ND NE NF XI XC YH YI Personal Injury - Vehicular Personal Injury - Other Property Damage Wrongful Death Other Tort REAL ESTATE AC Landlord - BULK Rent and Possession Unlawful Detainer Appl. to Enforce Mechanics Lien Eminent Domain/Condemnation - State Eminent Domain/Condemnation - Other Exception Foreclosure R Partition RY Quiet Title Other Real Estate Action EXTRAORDINARY REMEDY Declaratory Judgment CCCDT222 ­ JIS TR TB TS TC TT TD TU TE TV TF TW TG TX TH TY TI ASSOCIATE CIRCUIT R4 R1 R2 RS RA RB RC RD W RE RG RZ RH R3 RK ASSOCIATE CIRCUIT EO EA Replevin YJ Revival of Judgment Delinquent City License Fee Delinquent City Tax Delinquent County License Fee Delinquent County Tax Delinquent Sales Tax Delinquent State Taxes Personal Property Taxes Tax Action Other Other Miscellaneous Action Trial De Novo Small Claims Trial De Novo Will Contest (473.083 RSMo) Small Claims Certified Motion, Rules 24.035 or 29.15 Pro Forma Decree of Incorporation Transcript Judgment Mechanics Lien Contraband Destruction Order Foreign/Non-Case Document Owner/Lienholder Petition for Property Release SMALL CLAIMS Small Claims Under $100 Small Claims Over $100 YK YL YM YN YO YP YQ YR YZ Y2 Petition for Revocation of Conceal Carry Endorsement (571.117 RSMo) YX Appeal of Denial of Conceal Carry Endorsement (571.114 RSMo) YU ASSOCIATE YV YW YZ Revised 08/12 American LegalNet, Inc. www.FormsWorkFlow.com