FORM 1 Court of Common Pleas of Lackawanna County Civil Cover Sheet FOR CLERK OF JUDICIAL RECORDS USE ONLY Docket Number: Plaintiff's Name Defendant's Name _____________________________________________________________________________________ Plaintiff's Address Defendant's Address _____________________________________________________________________________________ Plaintiff's Name Defendant's Name _____________________________________________________________________________________ Plaintiff's Address Defendant's Address _____________________________________________________________________________________ Plaintiff's Name Defendant's Name _____________________________________________________________________________________ Plaintiff's Address Defendant's Address _____________________________________________________________________________________ Total Number of Plaintiffs Total No. of Defendants Commencement of Action __Complaint__Petition Action___Notice of Appeal ___Writ of Summons___Transfer from other Jurisdiction _________________________________________________________________________________________________________________ Amount of Controversy In Excess of Jurisdictional Amount? Yes___ No ___ Court Programs __Arbitration __ Jury __ Non-Jury __ Petiton __ Minor Court Appeal __Statutory Appeals ___ Other _____________________________________________________________________________________________________________________ Case Type and Code (See Instructions) _____________________________________________________________________________________ Statutory Basis for Cause of Action (See Instructions) _____________________________________________________________________________________ Remarks: _____________________________________________________________________________________ TO THE CLERK OF JUDICIAL RECORDS: Please enter my appearance on behalf of Plaintiff: Papers may be served at the address set forth below: ____________________________________________________________________________________________________________________ NAME OF PLAINTIFF'S ATTORNEY OR PRO SE PLAINTIFF ADDRESS _____________________________________________________________________________________________________________________ PHONE NUMBER FAX NUMBER _____________________________________________________________________________________________________________________ SUPREME COURT IDENTIFICATION NO. E-MAIL ADDRESS _____________________________________________________________________________________________________________________ SIGNATURE DATE ____________________________________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com LACKAWANNA COUNTY COURT OF COMMON PLEAS CIVIL COVER SHEET INSTRUCTIONS An attorney or pro se party filing a document commencing any type of civil action shall file a properly completed Civil Cover Sheet. Copies of the Civil Cover Sheet shall be attached to service copies of the document commencing the action. PARTIES Regardless of the type of action, the initiating party or parties shall be designated as Plaintiff or Plaintiffs and the responding party or parties shall be designated as Defendant or Defendants. Names of individuals shall be listed as last name, first name, middle initial. Full names of agencies and corporations shall be provided. Spouses shall be listed as separate parties unless the claim of one spouse is limited to a claim for consortium in which case the designation, et ux, or et vir shall be used. Where there are more than three plaintiffs or defendants, a supplemental form listing the additional parties shall be attached to the Cover Sheet. The section labeled "Remarks" is for procedural matters only. These may include such matters as related cases where consolidation might be advisable. Matters such as expected difficulty with service of process or status of settlement discussions do not belong in the section. CASE TYPE AND CODE DESIGNATION FAM Family Court FAM/CUST Custody FAM/DIV Divorce MCT Minor Court Appeal LAG Local Agency Appeal LAG/MVS Motor Vehicle Suspension LAG/ZB Zoning Board Appeal LAG/O Other Agency Appeals PCP/VAL Validation of Tax Title PCP/TS Tax Sale PCP/OBJ Objection to Tax Sale PCP/PRIV Petition to set aside private sale PCP/O Other Proceedings commenced by Petition CJ Confession of Judgment CLASS Class Action CNT Contract cases DECL Declaratory Judgment COND/DT Condemnation/Declaration of Taking TORT/AB Assault & Battery TORT/LS Libel & Slander TORT/FR Fraud TORT/BF TORT/WCP TORT/O NGL/MVA NGL/NF NGL/PI NGL/PREM NGL/PROD NGL/TT NGL/O MLP/D MLP/L MLP/M MLP/O EQ REPL RP RP/EJ RP/QT RP/MF RP/ML RP/PRT PP Tort Bad Faith Wrongful Use of Civil Process Other Torts Motor Vehicle Accident No-Fault Benefits Personal Injury Premises Liability Product Liability Toxic Tort Other Negligence Action Dental Malpractice Legal Malpractice Medical Malpractice Other Malpractice Equity Replevin Real Property Ejectment Quiet Title Mortgage Foreclosure Mechanic's Lien Partition Personal Property Actions STATUTORY CAUSE OF ACTION If the action is commenced pursuant to statutory authority, the specific statute must be identified with full citation. PENDING CASES Previously filed related cases must be identified by caption and docket number whether or not consolidated. American LegalNet, Inc. www.FormsWorkFlow.com