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Court of Common Pleas of Philadelphia |
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For Office of Judicial Records Use Only (Docket Number) |
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County Trial Division |
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Civil Cover Sheet |
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PLAINTIFF'S NAME |
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DEFENDANT'S NAME |
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PLAINTIFF'S ADDRESS |
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DEFENDANT'S ADDRESS |
TOTAL NUMBER OF PLAINTIFFS
COMMENCEMENT OF ACTION |
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Complaint |
Petition Action |
Notice of Appeal |
Writ of Summons |
Transfer From Other Jurisdictions |
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AMOUNT IN CONTROVERSY
$50,000.00 or less
More than $50,000.00
COURT PROGRAMS |
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Arbitration |
Mass Tort |
Minor Court Appeal |
Settlement |
Jury |
Savings Action |
Statutory Appeals |
Minors |
Non-Jury |
Petition |
Commerce (Completion of |
W/D/Survival |
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Addendum Required) |
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Other: _______________________________________ |
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CASE TYPE AND CODE (SEE INSTRUCTIONS)
STATUTORY BASIS FOR CAUSE OF ACTION (SEE INSTRUCTIONS)
RELATED PENDING CASES (LIST BY CASE CAPTION AND DOCKET NUMBER) |
IS CASE SUBJECT TO COORDINATION ORDER? |
Yes No
TO THE OFFICE OF JUDICIAL RECORDS:
Kindly enter my appearance on behalf of Plaintiff/Petitioner/Appellant:
Papers may be served at the address set forth below.
NAME OF PLAINTIFF'S/PETITIONER'S/APPELLANT'S ATTORNEY
ADDRESS (SEE INSTRUCTIONS)
SUPREME COURT IDENTIFICATION NO.
Instructions for Completing Civil Cover Sheet
Rules of Court require that a Civil Cover Sheet be attached to any document commencing an action (whether the action is commenced by Complaint, Writ of Summons, Notice of Appeal, or by Petition). The information requested is necessary to allow the Court to properly monitor, control and dispose cases filed. A copy of the Civil Cover Sheet must be attached to service copies of the document commencing an action. The attorney or non-represented party filing a case shall complete the form as follows:
A.Parties
i.Plaintiffs/Defendants
Enter names (last, first, middle initial) of plaintiff, petitioner or appellant ("plaintiff") and defendant. If the plaintiff or defendant is a government agency or cor- poration, use the full name of the agency or corporation. In the event there are more than three plaintiffs and/or three defendants, list the additional parties on the Supplemental Parties Form. Husband and wife are to be listed as separate parties.
ii.Parties' Addresses
Enter the address of the parties at the time of filing of the action. If any party is a corporation, enter the address of the registered office of the corporation.
iii. Number of Plaintiffs/Defendants: Indicate the total number of plaintiffs and total number of defendants in the action.
B.Commencement Type: Indicate type of document filed to commence the action.
C.Amount in Controversy: Check the appropriate box.
D.Court Program: Check the appropriate box.
E.Case Types: Insert the code number and type of action by consulting the list set forth hereunder. To perfect a jury trial, the appropriate fees must be paid as provided by rules of court.
Proceedings Commenced by Appeal
Minor Court
5M Money Judgment
5L Landlord and Tenant
5D Denial Open Default Judgment
5E Code Enforcement
Other:
Local Agency
5B Motor Vehicle Suspension -
Breathalizer
5V Motor Vehicle Licenses,
Inspections, Insurance
5C Civil Service
5K Philadelphia Parking Authority
5Q Liquor Control Board
5R Board of Revision of Taxes
5X Tax Assessment Boards
5Z Zoning Board
52Board of View
51Other:
Other:
Proceedings Commenced by Petition 8P Appointment of Arbitrators 8C Name Change - Adult
8L Compel Medical Examination
8D Eminent Domain
8E Election Matters
8F Forfeiture
8S Leave to Issue Subpoena
8M Mental Health Proceedings
8G Civil Tax Case - Petition Other:
Actions Commenced by Writ of Summons or Complaint |
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Contract |
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Professional Malpractice |
1C |
Contract |
2D |
Dental |
1T |
Construction |
4L |
Legal |
1O |
Other: |
2M |
Medical |
Tort |
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4Y |
Other: |
2B |
Assault and Battery |
1G Subrogation |
2L |
Libel and Slander |
Equity |
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4F |
Fraud |
E1 |
No Real Estate |
1J |
Bad Faith |
E2 |
Real Estate |
2E Wrongful Use of Civil Process |
1D |
Declaratory Judgment |
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Other: |
M1 |
Mandamus |
Negligence |
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Real Property |
2V |
Motor Vehicle Accident |
3R |
Rent, Lease, Ejectment |
2H |
Other Traffic Accident |
Q1 |
Quiet Title |
1F |
No Fault Benefits |
3D |
Mortgage Foreclosure - Residential |
4M |
Motor Vehicle Property Damage |
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Owner Occupied |
2F |
Personal Injury - FELA |
3F |
Mortgage Foreclosure - Not Residential |
2O |
Other Personal Injury |
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Not Owner Occupied |
2S |
Premises Liability - Slip & Fall |
1L |
Mechanics Lien |
2P |
Product Liability |
P1 |
Partition |
2T |
Toxic Tort |
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Prevent Waste |
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T1 |
Asbestos |
1V |
Replevin |
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TZ |
DES |
1H Civil Tax Case - Complaint |
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T2 |
Implant |
Other: |
3E |
Toxic Waste |
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Other: |
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F.Commerce Program
Commencing January 3, 2000 the First Judicial District instituted a Commerce Program for cases involving corporations and corporate law issues, in general. If the action involves corporations as litigants or is deemed a Commerce Program case for other reasons, please check this block AND complete the information on the "Commerce Program Addendum". For further instructions, see Civil Trial Division Administrative Docket 01 of 2000.
G.Statutory Basis for Cause of Action
If the action is commenced pursuant to statutory authority ("Petition Action"), the specific statute must be identified.
H.Related Pending Cases
All previously filed related cases, regardless of whether consolidated by Order of Court or Stipulation, must be identified.
I.Plaintiff's Attorney
The name of plaintiff's attorney must be inserted herein together with other required information. In the event the filer is not represented by an attorney, the name of the filer, address, the phone number and signature is required.
The current version of the Civil Cover Sheet may be downloaded from the FJD's website
http://courts.phila.gov