COMMON PLEAS COURT LAKE COUNTY, OHIO Case Designation Form Loc. R II(C)(1) For all cases except Foreclosure Case No. VS Judge Per LOC R. II (C)(3), refilling of cases previously dismissed under Civ. R. 41 must have a designation upon the face of the complaint that the action is being refiled. The word "REFILING" must appear in upper case letter under the word "COMPLAINT". Directly beneath the word "REFILING" the complaint shall identify the case number of this dismissed action. Former Case no. Case Categories (Mark one category only) Administrative Appeal (Specific ORC Sec.) Section Consumer Sales Practices: Actions commenced under applicable section of ORC Chapters: 109, 1315, 1317, 1321, 1322, 1333, 1334, 1345, 1349, 3953, 4505, 4549, 4710, 4712, 4719, 4775, 4905 or 5311 Contract or Quasi Contract Criminal Declaratory Judgment See Foreclosure Case Designation Form Foreign Judgment Malpractice (specify) Credit Card (CI) Personal Injury Product Liability Professional Tort Provisional Remedy (Replevin, Attachment, Garnishment) Workers Compensation Other Tort Other Civil The designation "money only" may not be used if one of the above specific categories is applicable. Further, the caption shall note any statutory provision that is unique to the particulate cause and controls the time within which the case is to proceed, once filed. (EX. Miscellaneous ­ Contest of Election (ORC Section 3515.10 ­ Hearing within 30 days.) Revised Code Section unique to this particular cause which controls the time within which the case is to proceed: Signature Printed name & Registration No. Firm name Address Phone number revised 9/27/13 nr American LegalNet, Inc. www.FormsWorkFlow.com