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Civil Case Cover Sheet (Chancery Court-Circuit Court) Form. This is a Tennessee form and can be use in Hamilton Local County.
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Tags: Civil Case Cover Sheet (Chancery Court-Circuit Court), 022, Tennessee Local County, Hamilton
CIVIL CASE COVER SHEET Check one: CHANCERY COURT CIRCUIT COURT Docket N0._______________________________________________________ Date__________________________________________ Attorney of Record________________________________________________________________ ______ I. Origin Original Proceeding Case Reopened Counter-claim Cross-claim 3rd Party Claim Intervening Claim Answer/Initial Reponssive Pleading O ther (Specify)_____________________________________________________________________ II. Type of Action (Check one ) Domestic Relations 361 Paternity 362 Legitimation 363 Adoption 364 Surrender 371 Divorce with minor children 372 Divorce without minor children 381 Order of Protection 391 Interstate Support-Incoming 392 Interstate Support-Outgoing 401 Other Domestic Relations (Specify)____________________________________________________________________________________________ ___ General Civil 461 Contract/Debt 462 Specific Performance 471 Damages/Torts 481 Real Estate Matter 491 Workers Compensation 501 Probate 511 Juvenile Court Appeal 512 General Sessions Appeal 513 Appeal from Admin. Hearing 571 Conservatorship 572 Guardianship 573 Trust 581 Miscellaneous General Civil (Specify)_____________________________________________________________________________________________ Other 541 Judicial Hospitalization Petition for: (Reopened Cases) 381 Order of Protection 382 Contempt 383 Residential Parenting/No Child Support 384 Residential Parenting/Child Support385 Child Support 387 Wage Assignment Hearing 551 Other____________________________________________________________________________________________ III. Total amount sued for $___________________________________ Specific type of damages or relief sought________________________________ _____ Statutory authority for suit, if any______________________________________________________________________________________________________ IV. Check one: Affidavit to proceedin forma pauperi s Cost Bond Surety_______________________________________________________________ V. JURY DEMAND (Check YES only if demanded in complaint) YES NO VI. RELATED CASES (if any) Docket N0.___________________ Judge_____________________________________________________________________ Date filed_____________________Status____________________________________________________________________ VII. PLAINTIFF/PETITIONER INFORMATION (List additional parties on supplemental form.) 1. Name________________________________________________________________________________________________________________________________ L ast F irst M iddle AKA DBA BNF___________________________________________________________________________________________________________ DOB______________________ Drivers License #____________________________________________________ _______________________________________________________________________________________ COMPANY NAME _______________________________________________________________________________________ ____________________________________________________________ _____________________ ADDRESS ATTORNEY BPR # _______________________________________________________________________________________ ______________________________________________________________________________________ CITY STATE ZIP ADDRESS _______________________________________________________________________________________ ______________________________________________________________________________________ EMPLOYER C ITY S TATE Z IP _______________________________________________________________________________________ ______________________________________________________________________________________ ADDRESS PHONE _______________________________________________________________________________________ CITY S TATE Z IP VIII. DEFENDANT/RESPONDENT INFORMATION (List additional parties on supplemental form.) 1. Name________________________________________________________________________________________________________________________________ L ast F irst M iddle AKA DBA BNF___________________________________________________________________________________________________________ DOB______________________ Drivers License #____________________________________________________ ________________________________________________________________________________________ COMPANY NAME ________________________________________________________________________________________ ____________________________________________________________ _____________________ ADDRESS ATTORNEY BPR # ________________________________________________________________________________________ ______________________________________________________________________________________ CITY STATE ZIP ADDRESS ________________________________________________________________________________________ ______________________________________________________________________________________ EMPLOYER C ITY S TATE Z IP ________________________________________________________________________________________ ______________________________________________________________________________________ ADDRESS PHONE ________________________________________________________________________________________ CITY S TATE Z IP TYPE OF SERVICE REQUIRED Out of County Sheriff________________________________ Publication (specify)______________________________________________________________ Local Sheriff Other (specify)___________________________________________________________________ Secretary of State Special Instructions_________________________________________________________________ Comm. Of Ins. ________________________________________________________________________________ IX. ASSOCIATED PARTY (Uninsured Motorist Carrier) INFORMATION 1. Name_________________________________________________________Address________________________________________________________________ Type of Service (specify)__________________________________________________________________________________________________________________ Are additional plaintiffs or defendants listed on a separate sheetYE? S NO [Form 022, Rev. 2002.08.05]
