Cover Sheet - Civil Case Filing Form
COVER SHEET
Civil Case Filing Form
(To be completed by Attorney/Party
Prior to Filing of Pleading)
Mississippi Supreme Court
Form AOC/01
Administrative Office of Courts (Revised 5/11/2000)
Court Identification Case Year
Docket Number
County # Judicial Court ID
District (CH, CI, CO)
Month Date Year
This area to be completed by Clerk
Docket Number
Local Docket ID
__________________________________
Case Number if filed prior to 1/1/94
In the Court of County
Short Style of Case:
Party Filing Initial Pleading: Type/Print Name MS Bar No.
Check (
) if Not an Attorney
Check (
) if Pro Hac Vice Signature
Compensatory Damages Sought: Punitive Damages Sought:
Is Child Support contemplated as an issue in this suit?
Yes No
If "yes" is checked, please submit a completed Child Support Information
Sheet with Final Decree/Judgment
P
LAINTIFF
-
P
ARTY
(
IES
)
INITIALLY BRINGING SUIT SHOULD BE ENTERED FIRST
(
FIRST NAME IN SHORT STYLE
)
-
E
NTER
A
DDITIONAL
P
LAINTIFFS ON
S
EPARATE
F
ORM
Individual ( )
Last Name First Name
Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
Address of Plaintiff
Check (
) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
Check (
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (d/b/a) or State Agency, and enter entity:
D/B/A
¡
Agency
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (
) if Business Plaintiff is filing suit in the name of an entity other than the above, and enter below :
D/B/A:
D
EFENDANT
-N
AME OF
D
EFENDANT
(
FIRST NAME IN SHORT STYLE
)
-
E
NTER
A
DDITIONAL
D
EFENDANTS ON
S
EPARATE
F
ORM
Individual ( )
Last Name First Name
Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
Check (
) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
Check (
) if Individual Defendant is acting in capacity as Business Owner/Operator (d/b/a) or State Agency, and enter entity:
D/B/A
¡
Agency
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (
) if Business Defendant is filing suit in the name of an entity other than the above, and enter below :
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar No. Or Name: Pro Hac Vice (
)
(If known)
In left hand column, check one (1) box
that best describes the nature of this
suit. In right hand column check all
boxes which indicate secondary claims.
Business/Commercial
¢£¢
¢¤¢
Accounting (Business)
¢£¢
¢¤¢
Bankruptcy
¢£¢
¢¤¢
Business Dissolution - Corporation
¢£¢
¢¤¢
Business Dissolution - Partnership
¢£¢
¢¤¢
Debt Collection
¢£¢
¢¤¢
Employment
¢£¢
¢¤¢
Examination of Debtor
¢£¢
¢¤¢
Execution
¢£¢
¢¤¢
Foreign Judgment
¢£¢
¢¤¢
Garnishment
¢£¢
¢¤¢
Pension
¢£¢
¢¤¢
Receivership
¢£¢
¢¤¢
Replevin
¢£¢
¢¤¢
Stockholder Suit
¢£¢
¢¤¢
Other
Domestic Relations
¢£¢
¢¤¢
Child Custody/Visitation
¢£¢
¢¤¢
Child Support
¢£¢
¢¤¢
Contempt
¢£¢
¢¤¢
Divorce: Fault
¢£¢
¢¤¢
Divorce: Irreconcilable Differences
¢£¢
¢¤¢
Domestic Abuse
¢£¢
¢¤¢
Emancipation
¢£¢
¢¤¢
Modification
¢£¢
¢¤¢
Paternity
¢£¢
¢¤¢
Property Division
¢£¢
¢¤¢
Separate Maintenance
¢£¢
¢¤¢
Termination of Parental Rights
¢£¢
¢¤¢
UIFSA (formerly URESA)
¢£¢
¢¤¢
Other
Contract
¢£¢
¢¤¢
Breach of Contract
¢£¢
¢¤¢
Installment Contract
¢£¢
¢¤¢
Insurance
¢£¢
¢¤¢
Product Liability under Contract
¢£¢
¢¤¢
Specific Performance
¢£¢
¢¤¢
Other
Probate
¢£¢
¢¤¢
Accounting (Probate)
¢£¢
¢¤¢
Birth Certificate Correction
¢£¢
¢¤¢
Commitment
¢£¢
¢¤¢
Conservatorship
¢£¢
¢¤¢
Guardianship
¢£¢
¢¤¢
Heirship
¢£¢
¢¤¢
Intestate Estate
¢£¢
¢¤¢
Minor's Settlement
¢£¢
¢¤¢
Muniment of Title
¢£¢
¢¤¢
Name Change
¢£¢
¢¤¢
Power of Attorney
¢£¢
¢¤¢
Testate Estate
¢£¢
¢¤¢
Will Contest
¢£¢
¢¤¢
Other
Statutes/Rules
¢£¢
¢¤¢
Bond Validation
¢£¢
¢¤¢
Civil Forfeiture
¢£¢
¢¤¢
Declaratory Judgment
¢£¢
¢¤¢
ERISA
¢£¢
¢¤¢
Eminent Domain
¢£¢
¢¤¢
Extraordinary Writ
¢£¢
¢¤¢
Federal Statutes
¢£¢
¢¤¢
Injunction or Restraining Order
¢£¢
¢¤¢
Municipal Annexation
¢£¢
¢¤¢
Racketeering (RICO)
¢£¢
¢¤¢
Railroad
¢£¢
¢¤¢
Seaman
¢£¢
¢¤¢
Other
Appeals
¢£¢
¢¤¢
Administrative Agency
¢£¢
¢¤¢
County Court
¢£¢
¢¤¢
Hardship Petition (Driver License)
¢£¢
¢¤¢
Justice Court
¢£¢
¢¤¢
MS Employmt Security Comm'n
¢£¢
¢¤¢
Municipal Court
¢£¢
¢¤¢
Oil & Gas Board
¢£¢
¢¤¢
Workers' Compensation
¢£¢
¢¤¢
Other
Children and Minors - Non-Domestic
¢£¢
¢¤¢
Adoption - Noncontested
¢£¢
¢¤¢
Consent to Abortion for Minor
¢£¢
¢¤¢
Removal of Minority
Torts-Personal Injury
¢¤¢
¢£¢
Bad Faith
¢¤¢
¢£¢
Fraud
¢¤¢
¢£¢
Loss of Consortium
¢¤¢
¢£¢
Malpractice - Legal
¢¤¢
¢£¢
Malpractice - Medical
¢¤¢
¢£¢
Negligence - General
¢¤¢
¢£¢
Negligence - Motor Vehicle
¢¤¢
¢£¢
Products Liability
¢¤¢
¢£¢
Wrongful Death
¢¤¢
¢£¢
Other
Mass Tort
¢¤¢
¢£¢
Asbestos
¢¤¢
¢£¢
Chemical Spill
¢¤¢
¢£¢
Dioxin
¢¤¢
¢£¢
Hand/Arm Vibration
¢¤¢
¢£¢
Hearing Loss
¢¤¢
¢£¢
Radioactive Materials
¢¤¢
¢£¢
Other
Real Property
¢¤¢
¢£¢
Adverse Possession
¢¤¢
¢£¢
Ejectment
¢¤¢
¢£¢
Eminent Domain
¢¤¢
¢£¢
Judicial Foreclosure
¢¤¢
¢£¢
Lien Assertion
¢¤¢
¢£¢
Partition
¢¤¢
¢£¢
Receiver Appointment
¢¤¢
¢£¢
Tax Sale: Confirmation/Cancellation
¢¤¢
¢£¢
Title, Boundary &/or Easement
¢¤¢
¢£¢
Other
Civil Rights
¢¤¢
¢£¢
Elections
¢¤¢
¢£¢
Habeas Corpus
¢¤¢
¢£¢
Post Conviction Relief
¢¤¢
¢£¢
Prisoner
¢¤¢
¢£¢
Other
I
N THE
C
OURT OF
C
OUNTY
,
M
ISSISSIPPI
J
UDICIAL
D
ISTRICT
,
C
ITY OF
Docket No.
-
Docket No. If Filed
File Yr. Chronological No. Clerk's Local ID
Prior to 1/1/94
PLAINTIFFS IN REFERENCED CAUSE - Page 2 of Plaintiffs Pages
IN ADDITION TO PLAINTIFF SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Plaintiff #2:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate and Enter Style:
Estate of
Check (T
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Plaintiff is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
P
LAINTIFF
: Bar# or Name Pro Hac Vice T
Not Attorney T
Plaintiff #3:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Plaintiff is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
P
LAINTIFF
: Bar# or Name Pro Hac Vice T
Not Attorney T
Plaintiff #4:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Plaintiff is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
P
LAINTIFF
: Bar# or Name Pro Hac Vice T
Not Attorney T
IN THE
C
OURT OF
C
OUNTY
,
M
ISSISSIPPI
J
UDICIAL
D
ISTRICT
,
C
ITY OF
Docket No.
-
Docket No. If Filed
File Yr. Chronological No. Clerk's Local ID
Prior to 1/1/94
PLAINTIFFS IN REFERENCED CAUSE - Page of Plaintiffs Pages
IN ADDITION TO PLAINTIFF SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Plaintiff # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate and Enter Style:
Estate of
Check (T
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Plaintiff is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
P
LAINTIFF
: Bar# or Name Pro Hac Vice T
Not Attorney T
Plaintiff # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Plaintiff is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
P
LAINTIFF
: Bar# or Name Pro Hac Vice T
Not Attorney T
Plaintiff # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Plaintiff is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
P
LAINTIFF
: Bar# or Name Pro Hac Vice T
Not Attorney T
I
N THE
C
OURT OF
C
OUNTY
,
M
ISSISSIPPI
J
UDICIAL
D
ISTRICT
,
C
ITY OF
Docket No.
-
Docket No. If Filed
File Yr. Chronological No. Clerk's Local ID
Prior to 1/1/94
DEFENDANTS IN REFERENCED CAUSE - Page 2 of Defendants Pages
IN ADDITION TO Defendant SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Defendant #2:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate and Enter Style:
Estate of
Check (T
) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Defendant is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar# or Name Pro Hac Vice T
Not Attorney T
Defendant #3:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Defendant is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar# or Name Pro Hac Vice T
Not Attorney T
Defendant #4:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Defendant is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar# or Name Pro Hac Vice T
Not Attorney T
I
N THE
C
OURT OF
C
OUNTY
,
M
ISSISSIPPI
J
UDICIAL
D
ISTRICT
,
C
ITY OF
Docket No.
-
Docket No. If Filed
File Yr. Chronological No. Clerk's Local ID
Prior to 1/1/94
DEFENDANTS IN REFERENCED CAUSE - Page of Defendants Pages
IN ADDITION TO DEFENDANT SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Defendant # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate and Enter Style:
Estate of
Check (T
) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Defendant is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar# or Name Pro Hac Vice T
Not Attorney T
Defendant # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Defendant is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar# or Name Pro Hac Vice T
Not Attorney T
Defendant # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Name Jr/Sr/III
Check (T
) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency and enter that name below:
D/B/A
Business:
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T
) if Business Defendant is filing suit in the name of an entity other than the name above and enter below
D/B/A
A
TTORNEY FOR THIS
D
EFENDANT
: Bar# or Name Pro Hac Vice T
Not Attorney T
CHILD SUPPORT INFORMATION SHEET
Please include all information known
I
N THE
C
OURT OF
C
OUNTY
,
M
ISSISSIPPI
J
UDICIAL
D
ISTRICT
, C
ITY OF
Docket No.
-
Docket No. If Filed
File Yr. Chronological No. Clerk's Local ID
Prior to 1/1/94
Father:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Drivers License #
Employer Name and Address: ( )
Employer Phone #
Mother:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Drivers License #
Employer Name and Address: ( )
Employer Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
F
OR
A
DDITIONAL
C
HILDREN
,
P
LEASE ATTACH ADDITIONAL FORMS
M
ANDATED PURSUANT TO
:
Federal Social Security Act Title IV-D,
Information will be sent to the
§§ 454(26)(A) and 454A(e)(4);
ADMINISTRATIVE
OFFICE
OF
COURTS
AND
Miss. Code Ann. §43-19-31(l)(iii) (Supp. 1999)
MDHS
CHILD
SUPPORT
ENFORCEMENT
DIVISION
C
IVIL
C
ASE
D
ISPOSITION
R
EPORT
I
N THE
C
OURT OF
C
OUNTY
,
M
ISSISSIPPI
J
UDICIAL
D
ISTRICT
, C
ITY OF
Docket No.
-
Docket No. If Filed
File Yr. Chronological No. Clerk's Local ID
Prior to 1/1/94
Dispositive of all Parties? Yes No, only the following Party(ies)
No, only the following Attorney(s)
Name Bar No.
Enter Ruling Judge Bar No.
OR
Ruling Judge Name
Date of Disposition ¨ ¨
Month Day Year
Action: Ruling on Motion
Ex Parte
Temporary Hearing
Contempt/Modification
Settlement Conference
Pre-Trial Conference
Case Administration
Discovery other than Motion Bench Trial
Jury Trial
Mediation Ordered
Damages Awarded:
Compensatory:
$
Punitive:
$
(List Amount or Range Letter):
Range A = 1¢-$500 Range B = $501-1,000 Range C = $1,001-10,000 Range D = $10.001-50,000
Range E = $50,001-100,000
Range F = $100,000-500,000 Range G = $500,000-1,000,000
Range H = $1,000,000+ Range 0 = -0-
Method of Disposition:
Default Judgment Final Judgment/Decree
Bankruptcy Discharged
Summary Judgment
Judgment by Stipulation
Estate Closed
Dismissed without Prejudice Agreed Judgment
Fiduciary Appointed
Dismissed with Prejudice
Orig. Judgment Modified Guardian/Conservatorship Appointed
Dismissed, Lack of Prosec.
Vacating Previous Ruling Protective Order (
Check if Domestic Violence( )
Dismissed by Agreement New Trial Granted Commitment
Change of Venue
Foreign Judgment Closed
Garnishment Issued
Transferred
Satisfaction of Judgment
Garnishment Abeyance Order Issued
Removed to Fed. Court
Drivers License Reins./Hard. Garnishment Canceled: Bankruptcy
Writ Issued
Canceled
Letters Rogatory
Affirmed on Appeal
Order of Mediation
Case Consolidation
Not Entered Yet
Other(list)
Was Child Support ordered in the disposition of the current matter? Yes No
If "Yes" was checked, make sure that Child Support Information Sheet was completed and submitted with the Civil Case Filing Form.