The civil information sheet neither replaces nor supplements the filing and service of pleadings or other papers as required by law. This form is required for use by the Clerk of the District Court for the purposes of initiating the civil docket sheet. This information will not be available to the public and this document will be stored in a separate location from the case file and then destroyed within a reasonable time. A new case will not be accepted without a cover sheet attached. (THIS FORM MUST BE TYPED OR PRINTED LEGIBLY). This form can be found at www.kscourts.org.
CIVIL INFORMATION SHEET
For Office Use Only
NATURE OF SUIT (Click or mark in one circle only If the case involves more than one of the following categories, indicate the
category having the highest dollar value)
CIVIL
If a CH. 61: $______________ (Judgment Demand Amount) CONTRACT Buyer Plaintiff Employment Dispute - Discrimination Employment Dispute - Other Fraud Landlord/Tenant - Unlawful Detainer Landlord/Tenant Dispute Other Seller Plaintiff (debt collection) Other Contract CIVIL APPEALS Administrative Agency Other Civil Appeal REAL PROPERTY Eminent Domain Mortgage Foreclosure Other Real Property MISCELLANEOUS 60-1507 Habeas Corpus Other Writs OTHER CIVIL SMALL CLAIMS STATE TAX WARRANT
TORT Asbestos Product Liability Automobile Tort Intentional Tort Legal Malpractice Medical Malpractice Other Professional Malpractice Premises Liability Slander/Libel/Defamation Tobacco Product Liability Toxic/Other Product Liability Other Tort
DOMESTIC
MARRIAGE DISSOLUTION/DIVORCE OTHER DOMESTIC RELATIONS PROTECTION FROM ABUSE PROTECTION FROM STALKING PATERNITY UIFSA NON-DIVORCE SUPPORT, CUSTODY OR VISITATION
PROBATE/ESTATE
GUARDIAN /CONSERVATOR Conservatorship/Trusteeship Guardianship Adult Guardianship - Minor Guardian/Conservator Adult Guardian/Conservator - Minor JURY DEMAND DETERMINATION OF DESCENT SEXUALLY VIOLENT PREDATOR DECEDENT ESTATE ELDER ABUSE OTHER PROBATE / ESTATE CARE AND TREATMENT NO ADOPTION
YES (Check yes only if jury demand is included in petition or as a separate pleading) YES NO SHERIFF IN STATE ____________
County
SUMMONS ATTACHED: SERVICE BY:
PROCESS SERVER/ATTORNEY
SHERIFF OUT OF STATE _____________
State
SHERIFF'S PROCESS FEE ATTACHED PLAINTIFF / SUBJECT INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
YES
NO DEFENDANT / OTHER PARTY INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME: ADDRESS: PHONE: SEX: SSN: DOB: DL OR STATE ID NO:__________________________ ALIAS NAMES USED:__________________________ __________________________________________ ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number) State and Number
NAME: ADDRESS: PHONE: SSN: DL OR STATE ID NO:_ ALIAS NAMES USED: ATTORNEYS (if known)
(Firm Name, Address, Telephone Number and Supreme Court ID Number)
SEX: DOB: _________________________
State and Number
FOR DOMESTIC CASES - NAME, DATE OF BIRTH AND SOCIAL SECURITY NUMBER OF EACH DEPENDENT CHILD:
(Name) (Date of Birth) (Social Security Number)
The requirement that Social Security numbers be included on domestic cases is mandatory, and authorized by the Supreme Court and federal law. On non-domestic cases, the Social Security number is not mandatory. The number is used for purposes of identification and may be disclosed as permitted by law. This form is not considered to be a public record.
07-11-06
ADDITIONAL CIVIL PARTY INFORMATION
PLTF/SUB/DEF/OTHER PTY INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY) (CIRCLE ONE)
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
PLTF/SUB/DEF/OTHER PTY INFORMATION NAME: ADDRESS:
(CIRCLE ONE)
NAME: ADDRESS: PHONE: SEX: DOB: SSN: DL OR STATE ID NO:__________________________ ALIAS NAMES USED:__________________________ __________________________________________ ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number) State and Number
PHONE: SSN: DL OR STATE ID NO:_ ALIAS NAMES USED: ATTORNEYS
SEX: DOB: _________________________
State and Number
(Firm Name, Address, Telephone Number and Supreme Court ID Number)
____________________________________________ PLTF/SUB/DEF/OTHER PTY INFORMATION PLTF/SUB/DEF/OTHER PTY INFORMATION NAME: ADDRESS: PHONE: SSN: DL OR STATE ID NO:_ ALIAS NAMES USED: ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number)
(CIRCLE ONE)
(CIRCLE ONE)
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME: ADDRESS: PHONE: SEX: SSN: DOB: DL OR STATE ID NO:__________________________
State and Number
SEX: DOB: _________________________
State and Number
ALIAS NAMES USED:__________________________ __________________________________________ ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number)
____________________________________________ PLTF/SUB/DEF/OTHER PTY INFORMATION PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE)
(CIRCLE ONE)
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME: ADDRESS: PHONE: SEX: SSN: DOB: DL OR STATE ID NO:__________________________
State and Number
NAME: ADDRESS: PHONE: SSN: DL OR STATE ID NO:_ ALIAS NAMES USED: ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number)
SEX: DOB: _________________________
State and Number
ALIAS NAMES USED:__________________________ __________________________________________ ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court ID Number)
____________________________________________ FOR DOMESTIC CASES - NAME, DATE OF BIRTH AND SOCIAL SECURITY NUMBER OF EACH DEPENDENT CHILD:
(Name) (Date of Birth) (Social Security Number)
The requirement that Social Security numbers be included on domestic cases is mandatory, and authorized by the Supreme Court and federal law. On non-domestic cases, the Social Security number is not mandatory. The number is used for purposes of identification and may be disclosed as permitted by law. This form is not considered to be a public record.
07-11-06