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) Workers' Compensation State Funded (D) Self Insured (K) Administrative Appeal (F) Commercial Docket Other Civil Consumer Fraud (N) Appropriation (P) Other Civil (H) Forfeiture Court Ordered Certificate of Title By submitting the complaint, with the signature of the Attorney, the Attorney affirms that the name of person with settlement authority and his/her direct phone number will be provided upon request to a party or counsel in this matter 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 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 Attorney Address Telephone ___________________________________ Approve/Deny Date ________________________________________ ________________________________________ ________________________________________ _________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com