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CIVIL CASE FILING STATEMENT
(Two-Party Cases) Please check the case type you are filing: CIV:
Tort Contract Foreign Judgment Habeas Corpus Divorce* Small Claims Name Change Paternity* Quiet Title Administrative Appeal Condemnation Other Writ Other Separate Maintenance* Claim and Delivery Forcible Entry & Detainer

DIV: SMC:

Annulment*

Complete a form for each additional Plaintiff or Defendant
Plaintiff: _________________________________ Last/Business name ______________________ First _________ ______ Middle Suffix

Address:_______________________________________________________________________ City: ________________________________________ State: __________ Zip: _____________ Date of Birth: _____ ____ ______ mm dd yyyy Social Security #: _____ - ____ - ______ and/or Drivers license # _____________State ____ Employer ID (if Plaintiff is a business or other entity) _________________________ Attorney: ____________________________ ____________________ _________ _______ Last First Middle Suffix Address: _______________________________________ Phone: _______________________ City: _______________________________________ State: __________ Zip: _____________ Defendant: __________________________________ Last/Business name __________________ First _________ Middle _______ Suffix

Address:_______________________________________________________________________ City: ________________________________________ State: __________ Zip: _____________ Date of Birth: _____ ____ ______ mm dd yyyy Social Security #: _____ - ____ - ______ and/or Drivers license #______________ State ___ Employer ID (if Defendant is a business or other entity) _________________________ Attorney: ____________________________ ____________________ ________ ________ Last First Middle Suffix Address: _______________________________________ Phone: _______________________ City: _______________________________________ State: __________ Zip: _____________ *For cases involving divorce, child support, and paternity, you must include your Social Security Number. 42 USC 666(a)(13)(B).
Revised 3-05 UJS Form 232