SUPERIOR COURT CIVIL CASE INFORMATION STATEMENT (CIS) COUNTY: N K S CIVIL ACTION NUMBER:__________________________ Caption: Civil Case Code: ___________ _______________________________________ Civil Case Type: ________________________________ (SEE REVERSE SIDE FOR CODE AND TYPE) _______________________________________ MANDATORY NON-BINDING ARBITRATION (MNA) ______ _______________________________________ Name and Status of Party filing document: _______________________________________ _________________________________________ _______________________________________ Document Type:(E.G.; COMPLAINT; ANSWER WITH COUNTERCLAIM) _______________________________________ _________________________________________ JURY DEMAND: YES ____ NO ____ ATTORNEY NAME(S): IDENTIFY ANY RELATED CASES NOW PENDING IN THE SUPERIOR COURT OR ANY RELATED CASES THAT HAVE BEEN CLOSED IN THIS COURT WITHIN THE LAST TWO YEARS BY CAPTION AND CIVIL ACTION NUMBER INCLUDING JUDGE’S _______________________________________ INITIALS: ATTORNEY ID(S): ________________________________________________ _______________________________________ FIRM NAME: ________________________________________________ EXPLAIN THE RELATIONSHIP(S): _______________________________________ ADDRESS: _______________________________________ _______________________________________ _______________________________________ _______________________________________ TELEPHONE NUMBER: _______________________________________ _______________________________________ _______________________________________ FAX NUMBER: OTHER UNUSUAL ISSUES THAT AFFECT CASE MANAGEMENT: _______________________________________ _______________________________________ E-MAIL ADDRESS: _______________________________________ _______________________________________ _______________________________________ (IF ADDITIONAL SPACE IS NEEDED, PLEASE ATTACH PAGE) THE PROTHONOTARY WILL NOT PROCESS THE COMPLAINT, ANSWER, OR FIRST RESPONSIVE PLEADING IN THIS MATTER FOR SERVICE UNTIL THE CASE INFORMATION STATEMENT (CIS) IS FILED. THE FAILURE TO FILE THE CIS AND HAVE THE PLEADING PROCESSED FOR SERVICE MAY RESULT IN THE DISMISSAL OF THE COMPLAINT OR MAY RESULT IN THE ANSWER OR FIRST RESPONSIVE PLEADING BEING STRICKEN. Revised 01/2019 SUPERIOR COURT CIVIL CASE INFORMATION STATEMENT (CIS) INSTRUCTIONS CIVIL CASE TYPE Please select the appropriate civil case code and case type (e.g., CODE - AADM and TYPE - Administrative Agency) from the list below. Enter this information in the designated spaces on the Case Information Statement. APPEALS MISCELLANEOUS AADM - Administrative Agency MAGM - AG Motion - Civil/Criminal Investigations * ACER - Certiorari MADB - Appeal from Disability Board * ACCP - Court of Common Pleas MAFF - Application for Forfeiture AIAB - Industrial Accident Board MAAT - Appointment of Attorney APSC - Public Service Commission MGAR - Appointment of Guardianship AUIB - Unemployment Insurance Appeal Board MCED - Cease and Desist Order MCON - Civil Contempt/Capias COMPLAINTS MCVP - Civil Penalty CABT – Abatement MSOJ - Compel Satisfaction of Judgment CASB – Asbestos MSAM - Compel Satisfaction of Mortgage CAAA - Auto Arb Appeal MCTO - Consent Order CMIS - Civil Miscellaneous MIND - Destruction of Indicia of Arrest * CACT - Class Action MESP - Excess Sheriff Proceeds CCON – Condemnation MHAC - Habeas Corpus CCLD – Complex Commercial Litigation Division (NCC ONLY) MTOX - Hazardous Substance Cleanup CDBT - Debt/Breach of Contract MFOR - Intercept of Forfeited Money CDEJ - Declaratory Judgment MISS - Issuance of Subpoena CDEF - Defamation MLEX - Lien Extension CEJM - Ejectment MMAN - Mandamus CATT - Foreign & Domestic Attachment MWIT - Material Witness * CFJG - Foreign Judgment MWOT - Material Witness - Out of State CFRD - Fraud Enforcement MRAT - Motion for Risk Assessment CINT - Interpleader MROP - Petition for Return of Property CLEM - Lemon Law MCRO - Petition Requesting Order CLIB - Libel MROD - Road Resolution CMAL - Malpractice MSEL - Sell Real Estate for Property Tax CMED - Medical Malpractice MSEM - Set Aside Satisfaction of Mortgage CPIN - Personal Injury MSSS - Set Aside Sheriff's Sale CPIA - Personal Injury Auto MSET - Structured Settlement CPRL - Products Liability MTAX - Tax Ditches CPRD - Property Damage MREF - Tax Intercept CRPV - Replevin MLAG - Tax Lagoons CSPD - Summary Proceedings Dispute MVAC - Vacate Public Road CCCP - Transfer from CCP MPOS - Writ of Possession CCHA - Transfer from Chancery MPRO - Writ of Prohibition MASS TORT MORTGAGES CABI - Abilify Cases MCOM - Mortgage Commercial CBEN - Benzene Cases MMED - Mortgage Mediation CFAR - Farxiga Cases MORT - Mortgage Non-Mediation (Res.) CHON - Honeywell Cases CMON - Monsanto Cases CPEL - Pelvic Mesh Cases MECHANICS LIENS CPLX - Plavix Cases LIEN - Mechanics Lien CPPI - PPI Cases CTAL - Talc Cases CTAX - Taxotere Cases CXAR - Xarelto Cases INVOLUNTARY COMMITMENTS INVC- Involuntary Commitment * Not eFiled DUTY OF THE PLAINTIFF Each plaintiff/counsel shall complete the attached Civil Case Information Statement (CIS) and file with the complaint. DUTY OF THE DEFENDANT Each defendant/counsel shall complete the attached Civil Case Information Statement (CIS) and file with the answer and/or first responsive pleading. Revised 10/2019 .