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STATE OF SOUTH CAROLINA COUNTY OF Plaintiff v. Defendant.

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IN THE CASE NO. -

MOTION AND ORDER INFORMATION FORM AND COVER SHEET

Plaintiff's Attorney: Defendant's Attorney: __________________________, Bar No. _________ __________________________, Bar No. _________ Address: ___________________________________ Address: ___________________________________ ___________________________________________ ___________________________________________ phone: _________________fax: ________________ phone: _________________fax: ________________ e-mail: ___________________ her: _____________ e-mail: ___________________ her: _____________ MOTION HEARING REQUESTED (attach written motion and complete SECTIONS I and III) FORM MOTION, NO HEARING REQUESTED (complete SECTIONS II and III) PROPOSED ORDER/CONSENT ORDER (complete SECTIONS II and III) SECTION I: Hearing Information Nature of Motion: ________________________________________________________________________ Estimated Time Needed:____________________________ Court Reporter Needed: YES / NO SECTION II: Motion/Order Type Written motion attached Form Motion/Order I hereby move for relief or action by the court as set forth in the attached proposed order. ___________________________________ _____________________ Signature of Attorney for Plaintiff / Defendant Date submitted SECTION III: Motion Fee PAID ­ AMOUNT: ___________________________________ EXEMPT: Rule to Show Cause in Child or Spousal Support (check reason) Domestic Abuse or Abuse and Neglect Indigent Status State Agency v. Indigent Party Sexually Violent Predator Act Post-Conviction Relief Motion for Stay in Bankruptcy Motion for Publication Motion for Execution (Rule 69, SCRCP) Proposed order submitted at request of the court; or, reduced to writing from motion made in open court per judge's instructions Name of Court Reporter: ___________________________________________________ Other: _________________________________________________________________ JUDGE'S SECTION Motion Fee to be paid upon filing of the attached . order. JUDGE Other: CODE: Date: . CLERK'S VERIFICATION Date Filed: ___________________ Collected by: MOTION FEE COLLECTED: CONTESTED ­ AMOUNT DUE: . .

SCCA/233 (11/03)