GREENE COUNTY COMMON PLEAS - GENERAL DIVISION CIVIL CASE INFORMATION FORM 45 North Detroit Street --- Xenia, Ohio 45385 Telephone (937) 562-5290 Facsimile (937) 562-5309 ***This form must be completed and filed with all Civil Cases*** PARTIES Case Number Plaintiff Attorney Reg. No. Counsel for Plaintiff -vs- Jury Demand (X) Prayer Amount $ Deposit Amount $ TYPE OF ACTION Administrative Appeal Appropriation Declaratory Judgment Forcible Entry Habeas Corpus Injunction Medical or Legal Malpractice Foreclosure Yes No Defendant Other Torts Personal Injury Product Liability Professional Tort Workers Compensation All Others (state type below) Violation of R.C. 1345-Consumer Protection Re-filing Information Is this a re-filing of a previous related case? (X) Yes No If Yes, please complete the following: Case Number Assigned Judge VS. Parties Suits Involving Like Issues and Similar Parties Are there any other cases pending that arise from the same incident or related parties? (X) Yes No If Yes, please complete the following: Case Number Assigned Judge VS. Parties "ORDER FOR SCHEDULING CONFERENCE" When answers have been filed and served by all named defendants, the plaintiff shall contact the assigned Judge to set a scheduling conference date immediately. Original - Clerk of Courts Copy - Counsel Signature of Attorney or Party Filing Case American LegalNet, Inc. www.FormsWorkFlow.com