DENISE M. KAMINSKI Geauga County Clerk of Courts Legal Office 100 Short Court Ste. 300 Chardon, Ohio 44024 Title Office 470 Center St. Bldg. 8 Chardon, Ohio 44024 COMMON PLEAS COURT GENERAL CASE DESIGNATION FORM ______________________________ vs. _________________________________ Judge:_____________________________________ Case no.________________________________ Has this case been previously filed and dismissed? Check one: Yes ( ) No ( ) If yes, list case number, Judge and/or Magistrate. Pending or closed related case(s) list case number and judge: ______________________________________________________________________________ Case No. TORT 1310 ( 1311 ( 1311 ( 1311 ( 1311 ( 1312 ( 1313 ( 1314 ( 1330 ( 1350 ( ) MOTOR VEHICLE ) MEDICAL MALPRACTICE ) DENTAL MALPRACTICE ) OPTOMETRIC MALPRACTICE ) CHIROPRACTIC MALPRACTICE ) LEGAL MALPRACTICE ) OTHER MALPRACTICE ) CONSUMER RELIEF (O.R.C. 1345) ) PRODUCT LIABILITY ) MISCELLANEOUS Judge/Magistrate CONTRACT 1382 ( ) BUSINESS 1384 ( ) REAL ESTATE 1390 ( ) COGNOVIT 1391 ( ) OTHER________________ REAL PROPERTY *** 1460 ( ) FORECLOSURE 1470 ( ) QUIET TITLE 1480 ( ) PARTITION 1481 ( ) OTHER________________ MISCELLANEOUS 1500 ( ) REPLEVIN 1501 ( ) OTHER__________________ ADMINISTRATIVE APPEALS 1540 ( ) EMPLOYMENT SERVICES 1550 ( ) WORKMEN'S COMPENSATION 1551 ( ) OTHER__________________ *** Please note all foreclosure, partition and quiet title cases require a preliminary judicial report. I certify that to the best of my knowledge the within case is not related to any now pending or previously filed, except as noted. _____________________________________ Firm Name _____________________________________ Address ___________________________________________ Attorney of Record (Print or Type) __________________________________________ Signature (440) 285-2222 834-1856 564-7131 Legal Office ext. 1960, Direct (440) 279-1960 Title Office ext. 1750, Direct: (440) 279-1750 Email: dkaminski@co.geauga.oh.us American LegalNet, Inc. www.FormsWorkFlow.com