Court Of Common Pleas Civil Cover Sheet - Pennsylvania
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1
2Supreme Court of Pennsylvania
Court of Common Pleas
For Prothonotary Use Only:
Civil Cover Sheet
Docket No:
County
_______________________________
The information collected on this form is used solely for court administration purposes. This form does not
supplement or replace the filing and service of pleadings or other papers as required by law or rules of court.
Commencement of Action:
Complaint
Writ of Summons
Petition
Notice of Appeal
S
Transfer from Another Jurisdiction
Declaration of Taking
E
C
Lead Plaintiff’s Name:
:
Lead Defendant’s Name
T
I
Check here if you are a Self-Represented (Pro Se) Litigant
O
Name of Plaintiff/Appellant’s Attorney: _____________________________________________________________________
N
_____ within arbitration limits
Dollar Amount Requested:
Are money damages requested? :
Yes
No
_____ outside arbitration limits
(Check one)
A
Class Action Suit?
Yes
No
Is this a
Nature of the Case:
Place an “X” to the left of the ONE case category that most accurately describes your
PRIMARY CASE. If you are making more than one type of claim, check the one that
you consider most important.
TORT
CONTRACT
CIVIL APPEALS
(do not include Mass Tort)
(do not include Judgments)
Intentional
Buyer Plaintiff
Administrative Agencies
Malicious Prosecution
Debt Collection: Credit Card
Board of Assessment
Motor Vehicle
Debt Collection: Other
Board of Elections
Nuisance
________________________
Dept. of Transportation
Premises Liability
________________________
Zoning Board
S
Product Liability (does not include
Statutory Appeal: Other
Employment Dispute:
mass tort)
_________________________
E
Discrimination
Slander/Libel/ Defamation
_________________________
Employment Dispute: Other
C
Other:
________________________
_________________________
Judicial Appeals
T
________________________
_________________________
MDJ - Landlord/Tenant
I
MDJ - Money Judgment
Other:
Other:
MASS TORT
________________________
O
_________________________
Asbestos
________________________
_________________________
N
Tobacco
Toxic Tort - DES
Toxic Tort - Implant
REAL PROPERTY
MISCELLANEOUS
Toxic Waste
Ejectment
Common Law/Statutory Arbitration
Other:
Eminent Domain/Condemnation
Declaratory Judgment
B
_________________________
Ground Rent
Mandamus
_________________________
Landlord/Tenant Dispute
Non-Domestic Relations
Mortgage Foreclosure
Restraining Order
PROFESSIONAL LIABLITY
Partition
Quo Warranto
Dental
Quiet Title
Replevin
Legal
Medical
Other:
Other:
Other Professional:
________________________
_________________________
_________________________
________________________
_________________________
_________________________
Pa.R.C.P. 205.5
2/2010
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