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CIVIL COVER SHEET The civil cover sheet neither

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11/25/2014
CIVIL COVER SHEET
The civil cover 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
.
NATURE OF SUIT (Mark only one - 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)
TORT CONTRACT REAL PROPERTY STATE TAX WARRANT
Asbestos Product Liability Buyer Plaintiff Eminent Domain
Automobile Tort Employment Dispute - Discrimination Mortgage Foreclosure
Intentional Tort Employment Dispute - Other Other Real Property
Legal Malpractice Fraud
Medical Malpractice Landlord/Tenant - Unlawful Detainer MISCELLANEOUS
Other Professional Malpractice Landlord/Tenant Dispute - Other 60-1507
Premises Liability Seller Plaintiff (debt collection) Habeas Corpus
Slander/Libel/Defamation Other Contract Other Writs
Tobacco Product Liability
Toxic/Other Product Liability CIVIL APPEALS OTHER CIVIL
Other Tort Administrative Agency
Other Civil Appeal SMALL CLAIMS
DOMESTIC
MARRIAGE DISSOLUTION/DIVORCE PROTECTION FROM ABUSE PROTECTION FROM STALKING UIFSA
OTHER DOMESTIC RELATIONS
NON-DIVORCE SUPPORT, CUSTODY OR VISITATION PATERNITY
PROBATE/ESTATE
GUARDIAN/CONSERVATOR DETERMINATION OF DESCENT ELDER ABUSE ADOPTION
Conservatorship/Trusteeship
Guardianship - Adult SEXUALLY VIOLENT PREDATOR
OTHER PROBATE/ESTATE
Guardianship - Minor
Guardian/Conservator - Adult DECEDENT ESTATE
CARE AND TREATMENT
Guardian/Conservator – Minor
JURY DEMAND YES (Check yes only if jury demand is included in petition or as a separate pleading)
NO
SUMMONS ATTACHED: YES
NO
SERVICE BY: PROCESS SERVER/ATTORNEY
SHERIFF IN STATE (County)
SHERIFF OUT OF STATE
(State)
SHERIFF’S PROCESS FEE ATTACHED
YES
NO
For Office Use Only
12/10/2014
PLAINTIFF/SUBJECT INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE:
SEX:
CELL PHONE:
E-MAIL:
SSN:
DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme
Court ID Number)
DEFENDANT/OTHER PARTY INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE:
SEX:
CELL PHONE:
E-MAIL:
SSN:
DOB:
DL OR STATE ID NO:
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.
11/25/2014
ADDITIONAL CIVIL PARTY INFORMATION
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE: SEX:
CELL PHONE:
E-MAIL:
SSN: DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE:
SEX:
CELL PHONE:
E-MAIL:
SSN: DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE: SEX:
CELL PHONE:
E-MAIL:
SSN: DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE:
SEX:
CELL PHONE:
E-MAIL:
SSN: DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
12/10/2014
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE:
SEX:
CELL PHONE:
E-MAIL:
SSN:
DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE: SEX:
CELL PHONE:
E-MAIL:
SSN:
DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE:
SEX:
CELL PHONE:
E-MAIL:
SSN:
DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
PLTF/SUB/DEF/OTHER PTY INFORMATION
(CIRCLE ONE) (ATTACH ADDITIONAL SHEET, IF NECESSARY)
NAME:
ADDRESS:
PHONE: SEX:
CELL PHONE:
E-MAIL:
SSN:
DOB:
DL OR STATE ID NO:
State and Number
ALIAS NAMES USED:
ATTORNEYS
(Firm Name, Address, Telephone Number and Supreme Court
ID Number)
12/10/2014
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.
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Completed 26 January 2021

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