LUCAS COUNTY COMMON PLEAS COURT CASE DESIGNATION TO: Bernie Quilter, Clerk of Courts CASE NO. JUDGE The following type of case is being filed: Professional Malpractice Legal Malpractice (L) Medical Malpractice (M) Product Liability (B) Other Tort (C) By submitting the complaint, with the signature of the Attorney, the Attorney Workers' Compensation affirms that the name of person with State Funded (D) settlement authority and his/her direct Self Insured (K) phone number will be provided upon request to a party or counsel in this matter Administrative Appeal (F) Other Civil Commercial Docket Consumer Fraud (N) Forfeiture Appropriation (P) Court Ordered Other Civil (H) Certificate of Title Copyright Infringement (W) This case was previously dismissed pursuant to CIVIL RULE 41 and is to be assigned to Judge , the original Judge at the time of dismissal. The previously filed case number was CI. This case is a civil forfeiture case with a criminal case currently pending. The pending case number is, assigned to Judge This case is a Declaratory Judgment case with a personal injury or related case currently pending. The pending case number is, assigned to Judge This case is to be reviewed for consolidation in accordance with Local Rule 5.02 as a companion or related case. This designation sheet will be sent by the Clerk of Courts to the newly assigned Judge for review with the Judge who has the companion or related case with the lowest case number. The Judge who would receive the consolidated case may accept or deny consolidation of the case. Both Judges will sign this designation sheet to indicate the action taken. If the Judge with the lowest case number agrees to accept, the reassignment of the case by the Administration Judge shall be processed. If there is a disagreement between the Judges regarding consolidation, the matter may be referred to the Administrative Judge. Related/companion case number Assigned Judge Approve/Deny Date Approve/Deny Date Attorney Address Telephone American LegalNet, Inc. www.FormsWorkFlow.com