La Civil Case Form – Fill Out and Use This PDF

APPENDIX 9.6

LOUISIANA CIVIL CASE REPORTING

Civil Case Cover Sheet - LA. R.S. 13:4688, Part G, §13 of the Louisiana Supreme Court General Administrative Rules, and Appendix 9.6 of the Louisiana District Court Rules

This civil case cover sheet shall be completed by counsel for the petitioner, counsel’s authorized representative, or by the self-represented litigant (if not represented by counsel) and submitted with the original petition filed with the court. The information should be the best available at the time of filing. This information does not constitute a discovery request, response or supplementation, and is not admissible at trial.

Suit Caption:
	vs.
Court: ___________________________	Docket Number: _____________________
Parish of Filing:____________________	Filing Date: _________________________

Name of Lead Petitioner’s Attorney: ________________________________________

Name of Self-Represented Litigant:__________________________________________

Number of named petitioners: _____

Number of named defendants: ____

Type of Lawsuit: Please check the categories which most appropriately apply to this suit (no more than 3 categories should be checked):

__Auto: Personal Injury	__ Auto: Property Damage
__Auto: Wrongful Death	__ Auto: Uninsured Motorist
__Asbestos: Property Damage	__ Asbestos: Personal Injury/Death
__Product Liability	__ Premise Liability
__Intentional Bodily Injury	__ Intentional Property Damage
__Intentional Wrongful Death	__ Unfair Business Practice
__Business Tort	__ Fraud
__Defamation	__ Professional Negligence
__Environmental Tort	__ Medical Malpractice
__ Intellectual Property	__ Toxic Tort
__ Legal Malpractice	__ Other Tort (describe below)
__ Other Professional Malpractice	__ Redhibition
__ Maritime	__ Class action (nature of case)
__ Wrongful Death	______________________________________
__General Negligence

Please briefly describe the nature of the litigation in one sentence of additional detail:

___________________________________________________________________________

___________________________________________________________________________

Following the completion of this form by counsel, counsel’s representative, or by the self-represented litigant, this document will be submitted to the Office of the Judicial Administrator, Supreme Court of Louisiana, by the Clerk of Court.

Name, address and contact information of person completing form:

Name ________________________________Signature______________________________________

Address ____________________________________________________________________________

Phone number:________________________E-mail address:__________________________________